Percutaneous interspinous spacer versus open decompression: a 2-year follow-up of clinical outcome and quality of life

Beyer, Frank; Yagdiran, Ayla; Neu, Peter; Kaulhausen, T.; Eysel, Peer; Sobottke, Rolf

doi:10.1007/s00586-013-2790-9

Cited by 37 publications

(31 citation statements)

References 27 publications

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“…Different models and materials are available, but the shared goal is to create a natural distraction between spinous process (inducing segmental kyphosis), which in turns restricts extension (induces flexion) in the treated segment. 1,6 Short-term advantages such as reduced morbidity, blood loss, operative time, and less hardware are intrinsic benefits of a minimally invasive procedure, such as those of the ISS. However, the success of long-term clinical outcomes, and/or even the need of this type of fixation after specific decompression techniques, are still controversial.…”

mentioning

confidence: 99%

“…Superior clinical outcomes have been reported for bilateral decompression alone when compared with stand-alone ISS without decompression in the treatment of lumbar spinal stenosis with neurogenic claudication. 1 However, surgical revision due to spinal instability has also been observed in cases of decompression without fixation, especially in cases of spondylolisthesis, but implantation of a bilateral pedicle screw system (BPSS) may be an excessive correction for microdecompression surgery and could potentially generate unnecessary risks. 23 Thus, the ISS may be a suitable alternative in certain decompression procedures or as supplemental fixation to interbody cages.…”

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confidence: 99%

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Biomechanical analysis of an interspinous fusion device as a stand-alone and as supplemental fixation to posterior expandable interbody cages in the lumbar spine

Gonzalez-Blohm

Doulgeris

Aghayev

et al. 2014

SPI

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Object In this paper the authors evaluate through in vitro biomechanical testing the performance of an interspinous fusion device as a stand-alone device, after lumbar decompression surgery, and as supplemental fixation to expandable cages in a posterior lumbar interbody fusion (PLIF) construct. Methods Nine L3–4 human cadaveric spines were biomechanically tested under the following conditions: 1) intact/control; 2) L3–4 left hemilaminotomy with partial discectomy (injury); 3) interspinous spacer (ISS); 4) bilateral pedicle screw system (BPSS); 5) bilateral hemilaminectomy, discectomy, and expandable posterior interbody cages with ISS (PLIF-ISS); and 6) PLIF-BPSS. Each test consisted of 100 N of axial preload with ± 7.5 Nm of torque in flexion-extension, right/left lateral bending, and right/left axial rotation. Significant changes in range of motion (ROM), neutral zone stiffness (NZS), elastic zone stiffness (EZS), and energy loss (EL) were explored among conditions using nonparametric Friedman test and Wilcoxon signed-rank comparisons (p ≤ 0.05). Results The injury increased ROM in flexion (p = 0.01), left bending (p = 0.03), and right/left rotation (p < 0.01) and also decreased NZS in flexion (p = 0.01) and extension (p < 0.01). Both the ISS and BPSS reduced flexion-extension ROM and increased flexion-extension stiffness (NZS and EZS) with respect to the injury and intact conditions (p < 0.05), but the ISS condition provided greater resistance than BPSS in extension for ROM, NZS, and EZS (p < 0.01). The BPSS increased the rigidity (ROM, NZS, and EZS) of the intact model in lateral bending and axial rotation (p ≤ 0.01), except in EZS for left rotation (p = 0.23, Friedman test). The incorporation of posterior cages marginally increased (p = 0.05) the EZS of the BPSS construct in flexion but these interbody devices provided significant stability to the ISS construct in lateral bending and axial rotation for ROM (p = 0.02), in lateral bending for NZS (p = 0.02), and in flexion/axial rotation for EZS (p ≤ 0.03); however, both PLIF constructs demonstrated equivalent ROM and stiffness (p ≥ 0.16), except in lateral bending where the PLIF-BPSS was more stable (p = 0.02). In terms of EL, the injury increased EL in flexion-extension (p = 0.02), the ISS increased EL for lateral bending and axial rotation (p ≤ 0.03), and the BPSS decreased EL in lateral bending (p = 0.02), with respect to the intact condition. The PLIF-ISS decreased lateral bending EL with respect to the ISS condition (p = 0.02), but not enough to be smaller or, at least, equivalent, to that of the PLIF-BPSS construct (p = 0.02). Conclusions The ISS may be a suitable device to provide immediate flexion-extension balance after a unilateral laminotomy, but the BPSS provides greater immediate stability in lateral bending and axial rotation motions. Both PLIF constructs performed equivalently in flexion-extension and axial rotation, but the PLIF-BPSS construct is more resistant to lateral bending motions. Further biomechanical and clinical evidence is required to strongly support the recommendation of a stand-alone interspinous fusion device or as supplemental fixation to expandable posterior interbody cages.

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confidence: 99%

mentioning

confidence: 99%

Biomechanical analysis of an interspinous fusion device as a stand-alone and as supplemental fixation to posterior expandable interbody cages in the lumbar spine

Gonzalez-Blohm

Doulgeris

Aghayev

et al. 2014

SPI

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“…Postoperatively, a steady rise in VAS has been reported to occur after 6 months [8], 1 year [19,39], and 2 years [18,34] of follow-up. Other studies have reported the maintenance of initially improved VAS up to 2 years [21, 27, 36•, 38] or even 3 years [13,23].…”

Section: Symptom Reliefmentioning

confidence: 99%

“…A similar pattern of short-term pain relief followed by return of symptoms has been shown in other studies, as well. One study indicated that, at 2 year follow-up, ODI and VAS levels even exceeded those reported preoperatively, indicating failure of the device [19].…”

Section: Aperius (Medtronic Memphis Tn Usa)mentioning

confidence: 99%

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

Pintauro

Duffy

Vahedi

et al. 2017

Curr Rev Musculoskelet Med

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Purpose of review Interspinous process devices (IPDs) are used in the surgical treatment of lumbar spinal stenosis. The purpose of this review is to compare the first generation with the next-generation devices in terms of complications, device failure, reoperation rates, symptom relief, and outcome. Recent findings Thirty-seven studies were included from 2011 to 2016. Device failure occurred at a mean of 3.7%, with a lower tendency to happen with next-generation IPDs. Reoperations occurred at a lower rate with the nextgeneration devices, with a mean follow up of 24 months (3.7% vs. 11.1%). The clinical outcome is not influenced by the type of IPD. Summary The long-term functionality of these devices is questionable, with radiologic changes and recurrence of symptoms often seen by 2 years following implantation. Next-generation devices do not appear to be subject to the same "bounce back" effect of symptom re-emergence after several years.

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CT/X-Ray-Guided Technique in Lumbar Spinal Canal and Foramina Stenosis: Spacers

Bonaldi

Manfrè

2016

Spinal Canal Stenosis

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Percutaneous interspinous spacer versus open decompression: a 2-year follow-up of clinical outcome and quality of life

Abstract: Decompression proved superior to percutaneous stand-alone spacer implantation in our two observational cohorts. Therapeutic failure was too high for interspinous spacers.

Cited by 37 publications

References 27 publications

Biomechanical analysis of an interspinous fusion device as a stand-alone and as supplemental fixation to posterior expandable interbody cages in the lumbar spine

Biomechanical analysis of an interspinous fusion device as a stand-alone and as supplemental fixation to posterior expandable interbody cages in the lumbar spine

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

CT/X-Ray-Guided Technique in Lumbar Spinal Canal and Foramina Stenosis: Spacers

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