Endoscopic spacers are used during surgery to reduce pain, adhesions, and radiation toxicity. In addition to pain reduction, these devices may reduce the risk of neurogenic claudication. However, a meta-analysis needs more data. Therefore, this procedure is not always recommended.
Reduces pain
Endoscopic spacers are an excellent option for patients who are experiencing chronic pain in the lower back. They are designed to enlarge the foraminal space and reduce pressure on nerves caused by lumbar spinal stenosis. They are also effective for relieving leg and buttock pain and reduce numbness.
Endoscopic spacers are small metal devices that open around the spinous processes of affected nerves. These devices are given to the patient with an IV or a tube in the arm. The patient is monitored closely by a skilled anesthesia clinician during the procedure. The implant is delivered through a small metal tube and is checked using live X-rays.
Increasingly, spacers are used in high-dose radiotherapy for tumors. Because of their high level of radiation protection, these devices reduce the risk of damage to surrounding normal tissue. The use of radioprotective spacers is becoming increasingly common, especially in prostate cancer.
Endoscopic spacers are also used for spinal stenosis. Patients who suffer from spinal stenosis can experience neurogenic claudication, which is caused by a compressed nerve in the lower back. The pain typically improves when the patient is sitting or leaning forward. These patients can experience pain in their buttocks, hips, and legs. Interspinous spacers can help these patients overcome their pain and increase the range of motion.
Reduces radiation induced toxicity
Radiation-induced toxicity is a concern associated with endoscopic procedures, but recent evidence suggests that using a spacer can reduce such toxicity. Spacers are devices that are implanted inside the body, and are known as radioprotective devices. Their use has become increasingly common for the treatment of prostate cancer and other cancers.
A recent study found that the use of a spacer during radiation therapy significantly reduced radiation toxicity. In this study, a saline-filled spacer was implanted inside the body of patients with retroperitoneal sarcoma before undergoing postoperative radiation therapy. It prevented radiosensitivity to the adjacent structures. Although there is still some risk associated with using such a device, the potential survival benefit was considered to be worthwhile.
The authors note that further study is needed to explore the role of spacers in radiotherapy and cancer. This study was supported by the Chinese Medicine Research Program and the Natural Science Foundation of Zhejiang Province. The authors declare no conflicts of interest. They acknowledge the support of all other funding sources.
The overall toxicity of the endoscopic spacer is minimal, and the average VRS score was 0.06 at the time of implant, 0.10 at the end of RT, 0.37 at six months, and 0.42 at 12 months. Only a small percentage of patients experienced acute Grade 3 toxicity. This was limited to patients who had spacer balloon insertions. Moreover, the analysis of post-implant MR imaging showed no abnormal or mal-rotated spacer positions.
Reduces adhesions
Endoscopic spacers are a useful adjunct in the treatment of endometriosis. They reduce the risk of adhesions, which can cause severe complications and a decreased quality of life. These devices can reduce adhesions by a large margin, with minimal surgical risk.
There are two main types of spacers: absorbable and non-absorbable. Surgical adhesions are the main cause of surgical failure, and a thin silastic splint implanted in the middle meatus may improve healing and patient outcomes.
Although the FDA has approved several barrier products to reduce adhesions, only a limited number of trials have been conducted using these devices. While they can isolate surgical tissue, they do not address the underlying mechanisms that lead to adhesions. Therefore, the limited use of these devices may provide an opportunity to develop novel solutions to the problem of adhesions.
Adhesions are the result of the body’s attempts to repair itself. They can appear as a thin layer of tissue similar to plastic wrap or as thick fibrous bands. Common locations for adhesions include the pelvic region, the bowel, and the area around the heart. The presence of adhesions can lead to chronic pain and a disorder called adhesion-related syndrome.
Reduces neurogenic claudication
Neurogenic claudication is a type of spinal stenosis that affects the legs. This condition is caused by an abnormal growth of the ligamentum flavum, which contributes to the narrowing of the spinal canal. Neurogenic claudication is relieved by a simple, minor procedure that debulks the affected ligamentum flavum and helps alleviate the symptoms. To be a candidate for this procedure, patients must have lumbar stenosis and neurogenic claudication.
This procedure is generally considered safe and effective in patients with moderate lumbar spinal stenosis. This procedure is often performed after conservative measures have failed. The benefits include a significant improvement in physical function. However, the procedure has some potential risks and should only be used in the setting of a patient’s condition.
A spacer is a surgical device that is inserted into a spinal canal. It can be implanted to reduce symptoms of neurogenic claudication. There are many different types of endoscopic spacers. These devices include: X-Stop, Coflex, Paradigm Spine, and Superion.
Maintains sinus patency
Endoscopic spacers can be placed within the sinuses to maintain ostial patency and to treat nasal polyps. They are not suitable for every patient, and there are potential risks and complications. Postoperative pain, inflammation, and scarring can occur. A patient should be vigilant about any foreign bodies left in the sinuses after the procedure, and they should be treated promptly.
The spacer is placed in the nasal cavity with bayonet forceps and is inserted into the middle meatus. The surgeon then directs the spacer superiorly under the middle turbinate axilla, with the superior “step” fitting into the frontal recess. The inferior portion of the stent sits on the inferior turbinate. The spacer remains in place for two to three weeks.
A 40-year-old man presenting for recalcitrant sinusitis presented with bilateral symptoms of chronic rhinosinusitis. He had previously been treated with antibiotics, nasal steroids, saline irrigation, and montelukast. Six years ago, he had undergone balloon sinuplasty. He had retained sinus spacers from his prior sinus surgery. The patient was cured of his nasal congestion and improved mucosal appearance.
Reduces rectal toxicity
An endoscopic spacer is a device that is placed in the rectal canal to facilitate passage of stools. The study showed that using spacers decreases rectal toxicity. The patients in the spacer group had a lower incidence of rectal toxicity (grade 1 or 2) and less urinary tract toxicity.
In this study, endoscopic spacers reduced rectal toxicity compared to gel spacers in patients receiving radiation. Patients were randomized according to their treatment plans. The study involved 258 patients. Patients were randomized to either spacer or gel. The patients were evaluated for acute toxicity by the Common Toxicity Criteria for Adverse Events (CTCAE) before and after the procedure. After completion of the procedure, the patients were re-evaluated to determine whether they had a decreased rectal toxicity after spacer placement.
The use of spacers reduces rectal toxicity during IMRT and brachytherapy. The introduction of an inert material such as hydrogel reduces the volume of the rectum that receives high dose radiation. The procedure is well tolerated by patients and is associated with few procedural side effects. There is a trend towards wider acceptance of spacers in clinical practice.
Cost-effectiveness
A recent study evaluated the cost-effectiveness of endoscopic spacers. It looked at the costs of the spacer and its associated procedure. This included any complications and other factors that could make the spacer less beneficial. The researchers calculated the cost-effectiveness ratio (ICER) per QALY gained.
The analysis used Medicare claims data to calculate costs, complications, and reoperation rates within three years. The authors then used the published literature to derive the utility of endoscopic spacers for D and F patients. Further, the researchers used sensitivity analyses to assess the failure rate after three years. After that, the failure rate rose steeply.
In the Advance Trial, the researchers compared the CESI and non-CESI endoscopic spacers in a randomized, controlled trial. The researchers compared the two types of spacers to the conventional ESS, which includes debridement, topical steroid sprays, and conventional postoperative packing.
The results of this study suggest that endoscopic spacers are cost-effective for GC prevention in Singapore. They reduce the need for radiation therapy and provide patients with improved patient outcomes. However, their cost-effectiveness must be carefully assessed before a medical decision is made.
