Can interspinous device, spire&amp;#8482;, be an alternative fixation modality in posterior lumbar fusion instead of pedicle screw?

Lee, Chang‐Hyun; Hyun, Seung-Jae; Kim, Ki-Jeong; Jahng, Tae-Ahn; Kim, Hyun-Jib

doi:10.5137/1019-5149.jtn.16097-15.1

Cited by 3 publications

(3 citation statements)

References 4 publications

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“…Although PLIF is widely used to treat degenerative lumbar spinal diseases with segmental instability, it is associated with various complications, such as muscle traction injury, nerve injury, deep wound infection, cerebrospinal fluid leakage, and postoperative pain. [ 1 , 2 ] Because of the complex perioperative complications associated with PLIF, various less invasive strategies for reducing comorbidity have been developed, including transforaminal lumbar interbody fusion or laminectomy alone. Although laminectomy without posterior fixation exhibits relief from radiating pain and neurogenic claudication symptoms, there are concerns about the risk of spondylolisthesis progression.…”

Section: Discussionmentioning

confidence: 99%

The efficacy and safety of decompression with interspinous fixation for lumbar spondylolisthesis when compared with posterior lumbar interbody fusion: A pilot study

Jung,

Hong

et al. 2024

Medicine

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Posterior lumbar interbody fusion (PLIF) is widely used to treat degenerative spondylolisthesis because it provides definitive decompression and fixation. Although it has several advantages, it has some disadvantages and risks, such as paraspinal muscle injury, potential intraoperative bleeding, postoperative pain, hardware failure, subsidence, and medical comorbidity. Lumbar decompressive bilateral laminectomy with interspinous fixation (DLISF) is less invasive and can be used on some patients with PLIF, but this has not been reported. To compare the efficacy and safety of DLISF in the treatment of low-grade lumbar spondylolisthesis with that of PLIF. We retrospectively analyzed the medical records of 81 patients with grade I spondylolisthesis, who had undergone PLIF or DLISF and were followed up for more than 1 year. Surgical outcomes, visual analog scale, radiologic outcomes, including Cobb angle and difference in body translation, and postoperative complications were assessed. Forty-one patients underwent PLIF, whereas 40 underwent DLISF. The operative times were 271.0 ± 57.2 and 150.6 ± 29.3 minutes for the PLIF and DLISF groups, respectively. The estimated blood loss was significantly higher in the PLIF group versus the DLISF group (290.7 ± 232.6 vs 122.2 ± 82.7 mL, P < .001). Body translation did not differ significantly between the 2 groups. Overall pain improved during the 1-year follow-up when compared with baseline data. Medical complications were significantly lower in the DLISF group, whereas perioperative complications and hardware issues were higher in the PLIF group. The outcomes of DLISF, which is less invasive, were comparable to PLIF outcomes in patients with low-grade spondylolisthesis. As a salvage technique, DLISF may be a good option when compared with PLIF.

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Section: Discussionmentioning

confidence: 99%

The efficacy and safety of decompression with interspinous fixation for lumbar spondylolisthesis when compared with posterior lumbar interbody fusion: A pilot study

Jung,

Hong

et al. 2024

Medicine

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“…Kim et al compared clinical outcome between the interspinous fusion devices and PS fixation and found significant evidence of a higher incidence of adjacent segmental degeneration (ASD) in the PS group than the interspinous devices ( 24 ). Lee et al studied a group of 26 patients (1:1 ratio of interspinous fusion devices and PS) and demonstrated that interspinous fusion devices can be used as an alternative to PS fixation ( 25 ). Concerns that ISP might lead to kyphosis by spine surgeons have also limited the adoption.…”

Section: Discussionmentioning

confidence: 99%

Prospective 5-year follow-up of L5–S1 versus L4–5 midline decompression and interspinous-interlaminar fixation as a stand-alone treatment for spinal stenosis compared with laminectomies

Chin,

Seale,

Spayde

et al. 2023

J Spine Surg

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Background Spinal stenosis treatment includes laminectomies with or without fusion or with interspinous distraction with or without fixation. Lack of published data on interspinous fixation devices (IFD) at L5–S1 is less considered as an option due to the smaller anatomical S1 spinous process and the higher stresses from the immobile sacrum. Our objective was to evaluate the outcomes of an IFD used as a stand-alone treatment for spinal stenosis at L5–S1 and L4–5 compared to historical data on open laminectomies. Methods Prospective comparative cohort study (Level 2) looking at collected preoperatively and postoperatively Visual Analog Scores (VAS) and Oswestry Disability Index (ODI) data, complications, and revision rates on 100 consecutive patients with spinal stenosis treated with midline decompression and InSpan (InSpan LLC, Malden, MA, USA) IFD, at L5–S1 and L4–5, up to five-year follow-up. All patients were treated by a single surgeon in an academic private practice. Historical published outcome data for open laminectomies were compared. Results Among the 100 patients, 45 underwent surgery at L5–S1 with a mean VAS pain score that decreased by 75% and ODI improved by 63% (P<0.001). Fifty-five patients had surgery at L4–5 with mean VAS and ODI scores improved by 80% and 66% (P<0.001) respectively. Preoperative and postoperative ODI and preoperative VAS scores were similar at L5–S1 and L4–5, however, postoperative VAS scores were significantly less for L4–5 versus L5–S1 (P<0.01). All surgeries were completed in less than one hour. There was a total of one L4–5 revision (1.8%) and two L5–S1 revisions (4.4%). Comparable laminectomy data showed decrease in VAS and ODI scores by 51% and 62% (P<0.05). The reoperation rate for laminectomies at five to ten years varied up to 24%. Conclusions Spinal stenosis patients treated with midline decompression and InSpan IFD, used as a stand-alone treatment for interspinous-interlaminar fixation, at L4–5 and L5–S1, showed improved outcome scores and low complication and revision rates at five years and were comparable to historical open laminectomy data. InSpan is a successful substitute for laminectomies in selected patients and was performed in less than 60 minutes. We recommend choosing the appropriately sized implant to achieve adequate distraction decompression to avoid recurrent symptoms.

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“…Besides high blood loss and longer hospital stay, screw malposition, cerebrospinal fluid leakage, permanent nerve root injury or deep tissue infection led to recent endeavours implicating minimally invasive techniques in order to minimise surgical trauma especially in moderate degenerative diseases [4][5][6]. Recently, interspinous devices have been discussed as an adjunct to lumbar fusion procedures [7][8][9]. However, because interspinous devices can also have complications such as fractures of the spinous process or device loosening with high revision rates, they are controversially discussed in the literature [10].…”

Section: Introductionmentioning

confidence: 99%

Functional and radiographic evaluation of an interspinous device as an adjunct for lumbar interbody fusion procedures

Spicher

Schmoelz

Schmid

et al. 2020

Biomedical Engineering / Biomedizinische Technik

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In the last decades, several interspinous process devices were designed as a minimally invasive treatment option for spinal stenosis. In order to minimise surgical trauma, interspinous process devices were recently discussed as an alternative posterior fixation in vertebral interbody fusions. Therefore, the purpose of this study was to evaluate the effect of a newly designed interspinous device with polyester bands (PBs) on range of motion (RoM) and centre of rotation (CoR) of a treated motion segment in comparison with an established interspinous device with spikes (SC) as well as with pedicle screw instrumentation in lumbar fusion procedures. Flexibility tests with an applied pure moment load of 7.5 Nm were performed in six monosegmental thoracolumbar functional spinal units (FSUs) in the following states: (a) native, (b) native with PB device, (c) intervertebral cage with PB device, (d) cage with SC and (e) cage with internal fixator. The resulting RoM was normalised to the native RoM. The CoR was determined of X-ray images taken in maximal flexion and extension during testing. In flexion and extension, the PB device without and with the cage reduced the RoM of the native state to 58% [standard deviation (SD) 17.8] and 53% (SD 15.7), respectively. The SC device further reduced the RoM to 27% (SD 16.8), while the pedicle screw instrumentation had the most reducing effect to 17% (SD 17.2) (p < 0.01). In lateral bending and axial rotation, the interspinous devices had the least effect on the RoM. Compared to the native state, for all instrumentations the CoR showed a small shift towards cranial. In the anterior-posterior direction, the SC device and the pedicle screw instrumentation shifted the CoR towards the posterior wall. The interspinous devices significantly reduced the RoM in flexion/extension, while in axial rotation and lateral bending only the internal fixator had a significant effect on the RoM.

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Can interspinous device, spire™, be an alternative fixation modality in posterior lumbar fusion instead of pedicle screw?

Cited by 3 publications

References 4 publications

The efficacy and safety of decompression with interspinous fixation for lumbar spondylolisthesis when compared with posterior lumbar interbody fusion: A pilot study

The efficacy and safety of decompression with interspinous fixation for lumbar spondylolisthesis when compared with posterior lumbar interbody fusion: A pilot study

Prospective 5-year follow-up of L5–S1 versus L4–5 midline decompression and interspinous-interlaminar fixation as a stand-alone treatment for spinal stenosis compared with laminectomies

Functional and radiographic evaluation of an interspinous device as an adjunct for lumbar interbody fusion procedures

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