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

Abstract

<jats:p> Lumbar spinal canal stenosis (LSCS) is one of the most common degenerative diseases in elderly patients. Failure of he treatment can occur, generally related to bone remodelling/fracture of spinous processes. PMMA augmentation of the posterior arch (spinoplasty, SP) has recently been proposed in case of neoplastic involvement. This study evaluated the efficacy of SP as a prophylactic treatment before introducing an interspinous spacer (IS). Moreover, we consider the possibility to treat patients who previously underwent IS implants with subsequent failure of the device, by introducing a second spacer at the same level, performing accessory SP. From January 2009 to September 2011, 174 patients with LSCS underwent CT-guided percutaneous IS implant in our department. From January 2011, all patients with osteoporosis underwent prophylactic SP before introducing the spacer. Moreover, in patients with re-stenosis related to bone remodelling and/or fracture, after strengthening the spinous processes with PMMA introduction, a second similar device was introduced to re-open the stenotic spinal canal. In patients with prophylactic treatment before spacer introduction, no restenosis occurred at three to 12 month follow-up. Patients who underwent second spacer implant at the same level after posterior arch augmentation again obtained a resolution of symptoms, and no further bone remodelling had occurred at follow-up controls. In conclusion, prophylactic SP prevents single spacer failure for bone remodelling/fracture, and allows failure repair by introducing a second spacer at the same level. </jats:p>

Successful use of percutaneous interspinous spacers and adjunctive spinoplasty in a 9 year cohort of patients

“…LSS is also a disease of the elderly who inherently carry a greater anesthetic risk. Minimally invasive and percutaneously inserted interspinous spacers have been shown to be both non-inferior in terms of patient outcomes and to have decisive benefits in terms of operating times and blood loss 2–26. This cohort of patients, the largest in a single study, confirms the existing cited literature which shows improvement in patient symptomatology and function after interspinous spacer insertion.…”

“…Augmentation of the spinous processes with polymethyl methacrylate (PMMA) serves to strengthen the underlying bone 11 12. Small-scale clinical and cadaveric studies have shown that prophylactic augmentation of the spinous processes (spinoplasty) above and below the treatment level may reduce the rate of PID failure 11–15. This study aims to retrospectively evaluate an approximately 9 year experience with PIDs and compare the device failure rate in patients who were prophylactically treated with spinoplasty with those who had a PID inserted alone.…”

Degenerative lumbar spinal stenosis treatment with Aperius™ PerCLID™ system and Falena® interspinous spacers: 1-year follow-up of clinical outcome and quality of life

“…Bone remodeling of the spinous process may be at the origin of a restenosis with a recurrence syndrome. For preventing those events, Manfrè 33 obtained good results with prophylactic percutaneous CT-guided posterior arch augmentation, with a PMMA (Polymethylmethacrylate) cement injection into the spinous process. In our opinion, it could be a good therapeutic strategy also if there were no cases of restenosis due to bone remodeling recorded in our multi-centric study.…”

Percutaneous Interspinous Spacer in Spinal-Canal-Stenosis Treatment: Pros and Cons

“…Recent meta-analysis focused on complications revealed no statistical difference in terms of complications between the IPD group and the surgical group in those series that reported it [14,19,22,23,24]; it is important to underline that the use of cement augmentation of the posterior vertebral arch (spinoplasty) in order to reduce the risk of spinal process fracture and IPD displacement has not been reported in any of the trials comparing IPD versus surgery for the treatment of DLSS (Figure 1) [25,26].…”