Interspinous spacers in the treatment of degenerative lumbar spinal disease: our experience with DIAM and Aperius devices

Abstract

Insertion of an interspinous devices has became a common procedure for the treatment of different clinical picture of degenerative spinal disease. We present our experience in 1,575 patients with the use of two different interspinous spacers: Device for Intervertebral Assisted Motion (DIAM) and Aperius PercLID system. From 2000 through 2008, 1,315 consecutive patients underwent DIAM implantation and 260 had an Aperius PercLID procedure. The main surgical indications included: degenerative disc disease (478 patients), canal and/or foraminal stenosis (347 patients), disc herniation (283 patients), black disc and facet syndrome (143) and topping-off (64 patients). 1,100 patients underwent a single level implant and 475 had a multiple level implant. Mean operating time was 35 min for DIAM and 7 min for Aperius. Complications were detected in 20 patients (10 cases of infections, 10 fractures of the posterior spinous processes). 40 patients were subsequently treated with posterior arthrodesis (n = 30) or total disc replacement (n = 10). Patient's postoperative clinical status was rated according to the modified Macnab criteria: symptoms resolution or improvement was achieved in 1,505 patients; and unchanged or unsatisfactory results in 70. Both techniques are safe, simple and less technically demanding. These approaches appear to be an effective alternative in selected cases, although conventional posterior lumbar decompression and fusion still may be required.

Posterior Arch Augmentation (Spinoplasty) before and after Single and Double Interspinous Spacer Introduction at the Same Level: Preventing and Treating the Failure?

“…Moreover, the indication for IS implants has recently been extended to lumbar discogenic pain, facet joint syndromes, disc herniation and low-grade instability 6 . Unfortunately, 7% to 13% of patients treated with IS experience an early recurrence ous CT-guided PMMA injection into the posterior arch.…”

Failure rates and complications of interspinous process decompression devices: a European multicenter study

“…Spacers placed between the lumbar spinous processes have become relatively common minimally invasive surgical treatment alternatives for a variety of spinal pathologies. 6,8,11,14,21,30 They provide an unloading distractive force to the stenotic motion segment and have the potential to relieve symptoms of degenerative disc disease among patients who experience relief in spine flexion. 2,37,41,48 Over the past several years, interspinous process spacers have provided alternatives to arthrodesis in older patients with degenerative lumbar disease.…”

Interspinous implants: are the new implants better than the last generation? A review

“…It is made of a titanium alloy core surrounded by pure titanium shell. The device was designed to be used as a stand-alone implant, requiring only local anesthesia and approximately 7 min for implantation [17]. Surgical exposure and implantation site preparation does not require removal of the interspinous ligament; instead, the spine is thought to be decompressed via interspinous process distraction.…”

“…Patel et al [23] and Fabrizzi et al [17] recruited the largest number of patients in RCT and retrospective studies, respectively (391 and 1315 patients). The main inclusion criteria were lumbar spine stenosis (LSS) at one or multiple levels, while some studies also recruited patients with lumbar disk herniation (LDH) with or without Myerding Grade I spondylolisthesis [10, 12, 14, 27, 36•, 37, 38, 40, 41, 45].…”