Minuteman Interspinous Spacer: A Minimally Invasive Solution for Spinal Stenosis and Instability

By John K. Hong, M.D. | 2/25/2025

Minuteman Interspinous Device

Chronic low back pain, spinal stenosis, and degenerative spinal conditions can severely impact quality of life. While conservative treatments like physical therapy, medications, and injections help many patients, some continue to experience debilitating pain and functional limitations. The Minuteman Interspinous Spacer offers a minimally invasive alternative to traditional fusion surgery, providing stabilization and relief for patients with spinal stenosis and instability.What is the Minuteman Interspinous Spacer?

The Minuteman Interspinous Spacer, developed by Spinal Simplicity, is a posteriorly implanted, minimally invasive spinal fusion device. It is designed to stabilize the spine by anchoring between the spinous processes, reducing excessive motion and decompressing neural structures. Unlike traditional spinal fusion, the Minuteman procedure requires a small incision, minimal tissue disruption, and can be performed in an outpatient setting.

The device is made of titanium alloy and includes a lateral plate with fixation screws that secure the implant in place, promoting spinal stability and eventual fusion through bone growth.

Clinical Indications

The Minuteman Spacer is primarily indicated for patients with:

• Lumbar spinal stenosis – narrowing of the spinal canal leading to nerve compression and pain.

• Degenerative disc disease – progressive disc degeneration causing instability and back pain.

• Spondylolisthesis (Grade I or II) – forward slippage of a vertebra that contributes to spinal instability.

• Failed conservative treatment – patients who have not found relief with physical therapy, medications, or injections.

• Adjacent segment disease (ASD) – patients who have had prior spinal fusion and are experiencing degeneration at adjacent levels.

  
  

The Procedure

The Minuteman procedure is performed through a lateral approach, typically under local anesthesia with sedation. The steps include:

1. Small incision – A small incision is made in the flank area.

2. Muscle dilation – Unlike open surgery, no major muscle detachment is needed.

3. Device placement – The spacer is inserted between the spinous processes and secured with screws.

4. Closure – The incision is closed with minimal suturing.

The entire procedure can be completed in under an hour and is usually done on an outpatient basis.

Benefits of the Minuteman Spacer

• Minimally invasive – Smaller incision, less blood loss, and reduced risk of complications.

• Faster recovery – Many patients resume light activities within a few days.

• Preservation of anatomy – Avoids major disruption of muscles and ligaments.

• Reduced hospital stay – Can be performed in an outpatient setting, reducing overall costs.

• Pain relief and improved function – Stabilizes the spine while alleviating nerve compression.

  
  

Potential Risks and Considerations

As with any medical procedure, there are risks, including:

• Infection

• Device migration or loosening

• Failure to achieve fusion

• Persistent pain or recurrence of symptoms

However, patient selection is crucial in determining the success of the procedure. Proper preoperative imaging and evaluation by an experienced spine physician help optimize outcomes.

Who is a Candidate for the Minuteman Spacer?

The ideal candidate is someone experiencing chronic back pain and instability due to spinal stenosis, spondylolisthesis, or degenerative disc disease, but who wishes to avoid traditional fusion surgery. Patients should have failed conservative treatments and not have severe osteoporosis or other contraindications that may prevent proper device fixation.

Conclusion

The Minuteman Interspinous Spacer represents an exciting advancement in minimally invasive spine care. It offers a less disruptive, faster-recovery alternative for patients with lumbar spinal stenosis and instability who are not responding to conservative treatments. If you or someone you know is struggling with persistent back pain, consult with a spine specialist to see if the Minuteman Spacer is a viable option.

For more information or to schedule a consultation, contact our clinic today at (435) 714-7180. Parkview has offices in Park City and Salt Lake City to conveniently serve you!

ReActiv8: A Breakthrough in Multifidus Neurorehabilitation for Chronic Low Back Pain

By John K. Hong, M.D. | 2/17/2025

Reactiv8 Multifidus Neurorehabilitation

The Missing Link in Chronic Low Back Pain: Multifidus Dysfunction

Chronic low back pain (CLBP) affects millions of people worldwide, often leading to disability, reduced quality of life, and reliance on medications or invasive procedures. While traditional treatments focus on pain management, one key underlying cause is frequently overlooked—multifidus muscle dysfunction.

The multifidus is a deep spinal muscle responsible for segmental stability and posture control. In many individuals with chronic low back pain, this muscle becomes inhibited and atrophied, leading to spinal instability and persistent pain.

ReActiv8®, a groundbreaking implantable neurostimulation system, directly addresses this issue by restoring neuromuscular control of the multifidus muscle, offering a novel, long-term solution for chronic low back pain.

Understanding Multifidus Dysfunction and Its Role in Chronic Pain

The multifidus muscle plays a crucial role in spinal stability, working reflexively to control small, precise movements of the vertebrae. However, in patients with chronic low back pain:

🔹 The reflexive activation of the multifidus is lost, often due to an initial injury or prolonged disuse.

🔹 This leads to muscle atrophy, reduced spinal stability, and ongoing pain.

🔹 Unlike typical muscle weakness, the multifidus does not automatically recover with exercise alone.

Traditional treatments—such as physical therapy, injections, and medications—may provide temporary relief but fail to restore proper neuromuscular activation of the multifidus.

This is where ReActiv8® comes in.

What Is ReActiv8 and How Does It Work?

ReActiv8® is an implantable neurostimulation system designed to reactivate the multifidus muscle by stimulating the L2 medial branch of the dorsal ramus, which controls the muscle's function.

🔹 Neurostimulation Therapy: ReActiv8 delivers electrical impulses to the nerve controlling the multifidus, causing targeted muscle activation and re-educating the neuromuscular system.

🔹 Restores Natural Spinal Stability: Unlike spinal cord stimulators that block pain signals, ReActiv8 restores muscle function, leading to long-term improvements in pain and mobility.

🔹 Minimally Invasive Procedure: The device is implanted through a small incision, with electrodes placed near the nerves controlling the multifidus.

Who Is a Candidate for ReActiv8?

ReActiv8 is designed for patients with chronic, nonspecific low back pain due to multifidus dysfunction, specifically those who:

✅ Have experienced chronic low back pain for six months or longer.

✅ Have failed to improve with conservative treatments (e.g., physical therapy, medications, injections).

✅ Do not have significant nerve compression (i.e., radiculopathy, sciatica).

✅ Have MRI findings consistent with multifidus atrophy and no significant structural instability (e.g., no severe disc herniations or spondylolisthesis requiring surgery).

✅ Show signs of motor control impairment rather than purely inflammatory or mechanical pain.

This makes ReActiv8 an ideal option for patients who are not candidates for spinal fusion or other invasive surgeries but still suffer from persistent low back pain.

The Treatment Process: What to Expect

1. Pre-Procedure Evaluation

• A thorough clinical assessment, including MRI and functional tests, determines if the patient has multifidus dysfunction.

• Patients may undergo a temporary external stimulation trial to assess response.

2. Minimally Invasive Implantation

• The procedure is performed under local anesthesia with sedation or general anesthesia.

• A small pulse generator is implanted in the lower back with electrodes positioned near the medial branch nerve of L2, stimulating the multifidus.

3. Rehabilitation & Neuromuscular Re-Education

• Patients use the ReActiv8 system twice daily for 30-minute sessions.

• Over several months, multifidus activation improves, leading to better spinal control and pain reduction.

4. Long-Term Recovery and Pain Reduction

• Studies show progressive improvement in function and pain levels over 1-2 years, with some patients experiencing complete resolution of chronic low back pain.

  
  

Clinical Evidence Supporting ReActiv8

ReActiv8 has been clinically validated in multiple trials, demonstrating its effectiveness for patients with multifidus dysfunction.

📌 ReActiv8-B Clinical Trial (2021):

• Long-term results showed sustained pain relief and functional improvement at 3 years.

• Over 60% of patients reported at least a 50% reduction in pain and significant improvement in quality of life (1).

📌 Multifidus Stimulation Outcomes (2022):

• Patients experienced a significant reduction in opioid use and improved functional scores (2).

📌 5-Year Follow-Up Data (2023):

• Ongoing pain relief and sustained improvement in function suggest long-lasting benefits (3).

  
  

Benefits of ReActiv8 Treatment

✔ Targets the Root Cause – Unlike spinal cord stimulators or injections, ReActiv8 restores normal neuromuscular function instead of just masking pain.

✔ Long-Lasting Pain Relief – Clinical studies show continued pain improvement even years after implantation.

✔ Minimally Invasive with Short Recovery – The implantation procedure is quick and low-risk, allowing for a rapid return to activity.

✔ Reduces Dependence on Medications – Many patients reduce or eliminate opioid use following treatment.

✔ Avoids Major Surgery – ReActiv8 provides a non-fusion, non-destructive alternative for chronic back pain sufferers.

Conclusion: Is ReActiv8 Right for You?

For patients suffering from chronic, nonspecific low back pain due to multifidus dysfunction, ReActiv8 offers a revolutionary approach to long-term pain relief. By reactivating the body's natural spinal stabilizers, this neurostimulation therapy can restore function, improve quality of life, and potentially eliminate the need for invasive spinal surgeries.

If you've struggled with chronic low back pain and haven’t found relief with traditional treatments, ReActiv8 may be the solution you've been searching for.

Interested in learning more? 

Contact our office at (435) 714-7180 today to see if you’re a candidate for ReActiv8 multifidus neurorehabilitation!

Click here for more information about Reactiv8!

References

1. Deckers K, et al. ReActiv8-B Trial: Long-Term Outcomes of Multifidus Neurostimulation.

2. Smuck M, et al. Pain Reduction and Functional Recovery Following Multifidus Stimulation. SAGE Journals

3. Gilligan C, et al. 5-Year Follow-Up on Multifidus Neurorehabilitation Outcomes. ScienceDirect

Basivertebral Nerve Ablation (Intracept): A Breakthrough Treatment for Vertebrogenic Pain

By John K. Hong, M.D. | 2/16/2025

Intracept Procedure

Understanding Vertebrogenic Pain: The Overlooked Cause of Chronic Low Back Pain

Chronic low back pain is one of the most common and debilitating conditions worldwide. While many cases are attributed to degenerative disc disease, facet joint arthritis, or muscular strain, a significant subset of patients suffer from vertebrogenic pain—a distinct and often underdiagnosed cause of chronic low back pain.

Vertebrogenic pain originates from damage and inflammation within the vertebral endplates, the thin layers of cartilage and bone that separate the spinal discs from the vertebral body. The basivertebral nerve (BVN), which innervates these endplates, plays a crucial role in transmitting pain signals from damaged vertebral structures.

In the past, treatment options for chronic low back pain were limited, often involving long-term medication use, physical therapy, spinal injections, or even surgery. However, basivertebral nerve ablation using the Intracept® procedure has emerged as an effective, minimally invasive solution for patients suffering from vertebrogenic pain.

Recognizing Vertebrogenic Pain: Symptoms and Diagnosis

Patients with vertebrogenic pain often present with specific characteristics that distinguish it from other types of low back pain:

✅ Deep, aching pain in the midline lower back (typically L3-S1 vertebrae).

✅ Pain worsens with prolonged sitting, bending, or activity.

✅ Pain is not primarily related to disc herniation, radiculopathy (sciatica), or facet joint arthritis.

✅ MRI findings show Modic type 1 or type 2 changes in the vertebral endplates, indicating inflammation and degeneration.

Vertebrogenic pain is diagnosed based on clinical symptoms and MRI imaging, which reveal characteristic Modic changes—a key indicator of vertebral endplate inflammation and BVN irritation.

Traditional Treatment Options for Chronic Low Back Pain

Before the advent of basivertebral nerve ablation, patients with vertebrogenic pain were typically managed using conventional treatments, which include:

• Physical Therapy & Core Strengthening – Helps improve spinal stability but may not address the root cause of vertebrogenic pain.

• Medications (NSAIDs, Muscle Relaxers, Opioids) – Provide temporary relief but do not offer a long-term solution.

• Epidural or Facet Joint Injections – May help some patients but are not targeted for vertebrogenic pain.

• Spinal Fusion Surgery – A last-resort option that is invasive and has mixed outcomes for patients with vertebrogenic pain.

  
  

Since these options do not directly target the source of vertebrogenic pain—the basivertebral nerve, they often result in incomplete or temporary pain relief.

The Intracept® Procedure: A Game-Changing Solution for Vertebrogenic Pain

How Basivertebral Nerve Ablation Works

The Intracept Procedure is a minimally invasive, FDA-approved treatment designed to disrupt pain transmission from the basivertebral nerve inside the vertebral body. The procedure involves:

1. Targeting the Basivertebral Nerve (BVN)

   • Using fluoroscopic guidance, a specialized radiofrequency probe is inserted into the affected vertebra through a small incision.

2. Ablation of the BVN

   • Controlled radiofrequency (RF) energy is applied to thermally ablate the basivertebral nerve, preventing it from transmitting pain signals.

3. No Hardware, No Implants

   • Unlike spinal fusion, Intracept preserves natural spinal motion and does not require hardware or implants.

     
     

Benefits of the Intracept Procedure

✔ Long-Lasting Pain Relief – Clinical studies show significant pain reduction lasting five years or more after the procedure (1).

✔ Minimally Invasive – No spinal implants, no large incisions, and a quick outpatient recovery.

✔ Targets the Root Cause – Unlike injections or medications, which provide temporary relief, Intracept addresses the pain at its source by disrupting BVN activity (2).

✔ Improves Function and Quality of Life – Patients experience reduced pain and increased mobility within weeks of the procedure (3).

✔ Avoids More Invasive Surgeries – Many patients who undergo Intracept can avoid unnecessary spinal fusions or long-term opioid use.

Who Is a Candidate for the Intracept Procedure?

Patients with chronic, refractory low back pain may be ideal candidates for basivertebral nerve ablation if they:

✅ Have experienced chronic low back pain for at least six months.

✅ Have not responded to physical therapy, medications, or injections.

✅ Show Modic type 1 or 2 changes on MRI at L3-S1.

✅ Have midline lower back pain rather than nerve-related (radicular) pain.

Clinical Evidence Supporting Intracept

Several landmark studies have demonstrated the effectiveness of basivertebral nerve ablation:

📌 SMART Trial (2019): Patients who underwent Intracept showed significant pain relief and functional improvement compared to non-surgical management (4).

📌 5-Year Follow-Up Study (2021): Demonstrated that pain relief was sustained long-term, with over 70% of patients reporting significant improvement (5).

📌 Long-Term Outcomes (2023): Confirmed that basivertebral nerve ablation provided superior pain reduction compared to standard non-operative treatments (6).

Conclusion: Is Intracept Right for You?

The Intracept Procedure is revolutionizing the treatment of vertebrogenic pain, offering long-lasting relief for patients suffering from chronic low back pain caused by vertebral endplate inflammation.

For individuals who have tried and failed conventional treatments, Intracept provides a minimally invasive, scientifically proven solution that directly targets the basivertebral nerve—addressing the root cause of their pain.

If you or a loved one suffers from chronic, midline low back pain that has not improved with conservative treatments, you may be a candidate for basivertebral nerve ablation.

Want to learn more? Contact our office today at (435) 714-7180 to see if the Intracept Procedure is right for you!

Click here for more information about Intracept!

References

1. Fischgrund JS, et al. Basivertebral nerve ablation for the treatment of chronic low back pain: Five-year outcomes.

2. Khalil JG, et al. Intracept basivertebral nerve ablation for chronic vertebrogenic pain: Clinical outcomes and evidence.

3. Smuck M, et al. Pain relief and functional improvement following BVN ablation. SAGE Journals

4. SMART Trial. Clinical evaluation of BVN ablation for vertebrogenic pain.

5. Becker S, et al. Prospective randomized study of BVN ablation vs. sham control. LWW