Column 「Introducing Our Clinic 8」The Florence and Q Florence Methods – A New Treatment for Spinal Canal Stenosis and Spondylolisthesis
This time, we want to introduce our new treatment methods, the Florence Method and Q Florence Methods
Symptoms and treatment of spinal stenosis
So far, we have introduced the Cellgel Method as a treatment for degenerative disc disease.
This time, we will explain a new treatment for spinal stenosis.
Spinal stenosis is when the nerves in your back become narrow, causing pain and numbness.
That’s right.
The deformed bones and ligaments narrow the spinal canal, causing pain and numbness in the nerve-controlled areas (lower back and lower limbs).
Another well-known symptom is intermittent claudication, in which the patient is unable to walk for long periods of time and must take breaks along the way.
This is a typical MRI image.
This is an MRI of a patient with spinal stenosis:
Comparing this with a normal image, you can see that the spinal canal is narrowed.
The narrowing of the spinal canal can cause symptoms such as pain and numbness.
There are a lot of painful symptoms.
What kind of treatment is there for spinal stenosis?
Conventional treatment begins with symptomatic treatment such as medication, rehabilitation, and block injections, and when symptoms become severe, such as urinary or bowel problems, surgical treatment such as fusion or decompression surgery is usually recommended.
The treatment process is the same as for degenerative and herniated discs, and begins with symptomatic treatment.
Well, when the cause is clear, such as a fracture or injury, it can be possible to provide treatment tailored to that, but since there are various causes for lower back pain, it is difficult to immediately undergo surgery.
For that reason, we often prescribe painkillers to relieve the pain first.
I see, so that’s why when you go to a local hospital and say you have a backache, you’re given some painkillers and a compress and that’s it.
By the way, who or what are Florence and Q Florence?
Treatment flow of the Florence Method and the Q-Florence Method
Our new treatment methods, the Florence and Q Florence Method are positioned somewhere between symptomatic treatment and surgical treatment.
It meets the needs of patients who are not getting better despite painkillers and rehabilitation, but do not want to go as far as surgery.
I see, it’s a treatment method that’s somewhere in the middle.
How is it performed?
We do not use general anesthesia, and treatment is performed under sedation.
This treatment can be performed even by those who cannot undergo general anesthesia or immobilization surgery.
What exactly is sedation?
The patient is placed in a state of partial or full loss of consciousness and is relieved of anxiety and feeling pain.
If the sedation is not strong enough, you may feel like you are in a drowsy state that happens right before you fall asleep.
Deep sedation means you no longer feel pain, just like with general anesthesia.
A 2-3cm incision is made on the side of the body, through which the implant is inserted and placed between the spinous processes.
Because it is inserted from the side of the body, it causes less damage to normal tissue than conventional fixation surgery.
See the image below for an idea of what it looks like:
The implant is placed in the interspinous ligament between the spinous processes.
Since only the interspinous ligament is passed, the supraspinous ligament, which would otherwise be damaged during fixation surgery, can be preserved.
The implant is inserted from the side and placed between the bones!
By inserting the implant from the side, we preserve as much normal tissue as possible.
Depending on the implant, it is called the Florence method or the Q-Florence method.
So why does inserting an implant improve symptoms?
The Florence method expands the space around the spinal canal
The treatment procedures for the Florence method and the Q-Florence method are roughly the same, but the treatment effects are different, so I will explain each one one by one.
First, let me explain the Florence method.
By inserting the implant between the spinous processes, the upper vertebrae are raised slightly.
This slightly raised state is the same as a forward leaning posture.
When you have back pain, don’t you often find it more comfortable to bend rather than arch your back?
Yes, that is true…
Leaning forward expands the space around the spinal canal, making it more comfortable.
Inserting an implant creates the same state as a leaning forward posture, alleviating symptoms.
I see, so by inserting an implant you can create a comfortable situation!
Because it has the effect of expanding the space, the corresponding disease is spinal canal stenosis caused by thickening of the ligamentum flavum or mild spondylolisthesis.
Another advantage of the Florence method is that it limits movement less than traditional fusion surgery.
Does the weak pressure applied by the implant mean the implant will move?
Yes, that’s true. It is not suitable for patients with lumbar instability, such as those whose lumbar spine moves significantly when bending forward or backward, or those with a large degree of slippage.
To compensate for this drawback, the Q Florence method is available.
What is lumbar instability?
The balance of the lumbar vetrebrae is lost. For example, it may look like the X-Ray below.
A condition in which the lumbar spine slips forward or backward
Misalignment of the lumbar vertebrae
The Q-Florence Method eliminates lumbar instability
The Q Florence method has a stronger fixation force than the Florence method. Therefore, it has an effect similar to that of fusion surgery. It prevents the vertebral body from moving due to movement and causing spinal canal stenosis.
Since the implant is inserted into the interspinous ligament, the space expands slightly, so it is effective even if thickening of the ligamentum flavum occurs at the same time.
So the type of implant that is inserted depends on the reason the spinal canal is narrowed?
That is how it is.
We use MRIs, X-rays, and physical examinations to determine the cause of symptoms and propose appropriate treatment methods.
There are many different causes of spinal stenosis, right?
That’s right.
If the spinal canal stenosis is caused by something wrong with the bones, this treatment method will not be effective.
It’s not possible to treat everything.
I’m sorry, but that is the case.
However, I hope that this can be of help as a new treatment for patients who do not want or can not undergo surgery.
If you are suffering from spinal stenosis or intermittent claudication, please feel free to contact us at gai-info@ilclinic.or.jp
