Editorial. Interspinous spacers for lumbar stenosis: time for obsolescence?

umbar spinal stenosis (LSS) is the most common indication for spine surgery in the elderly population.This condition is prevalent in approximately 47% of 60-to 69-year-old individuals and increases with age. 1 In the US, rates of surgery for LSS have rapidly increased over time. 2 Although open laminectomy has traditionally been considered the gold-standard procedure, associated complications, the need for general anesthesia, and resource utilization have led to development of other interventions.Interspinous distraction devices (IDDs) are one example.The X-Stop (Medtronic) was approved in 2005 by the US FDA for use in patients with 1-or 2-level LSS and symptoms that improve with flexion.In one study, results with the X-Stop were favorable at the 1-year outcome compared with those of nonsurgical management; 59% of the X-Stop cohort reported significant improvement in the symptom severity and physical function domains of the Zurich Claudication Questionnaire compared with 12% of the nonsurgical cohort, and the authors reported a 1-year reoperation rate of 6% in the X-Stop cohort. 3Other studies have compared X-Stop with lumbar laminectomy and found improvement in outcomes among both cohorts; however, reoperation rates were consistently noted to be significantly higher among the X-Stop cohort. 5,6Since X-Stop can be implanted in an outpatient setting under local anesthesia with shorter procedural times than those required for laminectomy, questions remain regarding whether this device could play a role in the treatment of LSS despite the high reoperation rate.In this issue of Journal of Neurosurgery: Spine, Borg et al. 4 present results of the United Kingdom Cost-Effectiveness and Quality of Life After Laminectomy or X-Stop (CELAX) open-label, randomized controlled trial.Cost was measured per patient episode and included device, operating time, and admission costs.Quality of life (QOL) was measured using the EQ-5D as the primary outcome.Both the laminectomy and X-Stop cohorts reported im-