Neurosurgical Management of Interspinous Device Complications: A Case Series

Abstract

BackgroundBest practice guidelines for treating lumbar stenosis include a multidisciplinary approach, ranging from conservative management with physical therapy, medication, and epidural steroid injections to surgical decompression with or without instrumentation. Marketed as an outpatient alternative to a traditional lumbar decompression, interspinous process devices (IPDs) have gained popularity as a minimally invasive stabilization procedure. IPDs have been embraced by non-surgical providers, including physiatrists and anesthesia interventional pain specialists. In the interest of patient safety, it is imperative to formally profile its safety and identify its role in the treatment paradigm for lumbar stenosis.Case DescriptionWe carried out a retrospective review at our institution of neurosurgical consultations for patients with hardware complications following the interspinous device placement procedure. Eight cases within a 3-year period were identified, and patient characteristics and management are illustrated. The series describes the migration of hardware, spinous process fracture, and worsening post-procedural back pain.ConclusionsIPD placement carries procedural risk and requires a careful pre-operative evaluation of patient imaging and surgical candidacy. We recommend neurosurgical consultation and supervision for higher-risk IPD cases.

Bibliometric analysis of interspinous device in treatment of lumbar degenerative diseases

“…[39][40][41][42][43][44] Interspinous process indirect decompression is still considered an experimental procedure, and the device's attractiveness to many surgeons may be somewhat constrained by unfavorable clinical outcomes reported in medical literature. [24,[45][46][47]…”

Lumbar interspinous devices: indications, surgical aspects, clinical considerations

“…In some western countries ISDs are widely implanted by physiatrists and interventional pain specialists; recently, a small series of complications related to ISD implants, in particular, the migration of the spacer in the spinal canal, performed by pain specialists, was reported [17]. Over the last two decades, the industry has promoted the ISD surgical implant and, based upon its presumed 'easiness of technique', it forced its use by 'non-spine surgeons'; the matters of incorrect surgical indication, poor knowledge of the biomechanics of the spinal column, inability to manage potential complications, have rocketed.…”

“…Over the last two decades, the industry has promoted the ISD surgical implant and, based upon its presumed 'easiness of technique', it forced its use by 'non-spine surgeons'; the matters of incorrect surgical indication, poor knowledge of the biomechanics of the spinal column, inability to manage potential complications, have rocketed. has been strongly recommended that 'spinal instrumentation, however minimally invasive, should be performed by fellowshiptrained spine surgeons' and, in the same way, a consultation with an experienced spine surgeon before an ISD implantation should be performed [17].…”