Stress Fracture of Bilateral Posterior Facet After Insertion of Interspinous Implant

Chung, Ki Sup; Hwang, Yoon Sub; Koh, Sung Hye

doi:10.1097/brs.0b013e31819fd3a0

Cited by 21 publications

(5 citation statements)

References 16 publications

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“…Spinous process fracture, observed here and in other studies of IPDs, may be considered as potentially risk related specifically to interspinous process decompression, both in terms of the procedure and the device itself [11][12][13][14]. Fracture rates, and the means of detecting fractures, vary between studies, making direct comparisons difficult.…”

Section: Discussionmentioning

confidence: 74%

Clinical evaluation of the preliminary safety and effectiveness of a minimally invasive interspinous process device APERIUS® in degenerative lumbar spinal stenosis with symptomatic neurogenic intermittent claudication

et al. 2012

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Purpose New interspinous process decompression devices (IPDs) provide an alternative to conservative treatment and decompressive surgery for patients with neurogenic intermittent claudication (NIC) due to degenerative lumbar spinal stenosis (DLSS). APERIUS Ò is a minimally invasive IPD that can be implanted percutaneously. This multicentre prospective study was designed to make a preliminary evaluation of safety and effectiveness of this IPD up to 12 months post-implantation. Methods After percutaneous implantation in 156 patients with NIC due to DLSS, data on symptoms, quality of life, pain, and use of pain medication were obtained for up to 12 months.Results Early symptom and physical function improvements were maintained for up to 12 months, when 60 and 58 % of patients maintained an improvement higher than the Minimum Clinically Important Difference for Zurich Claudication Questionnaire (ZCQ) symptom severity and physical function, respectively. Leg, buttock/groin, and back pain were eased throughout, and the use and strength of related pain medication were reduced. Devices were removed from 9 % of patients due to complications or lack of effectiveness. Conclusions Overall, in a period of up to 12 months follow-up, the safety and effectiveness of the APERIUS Ò offered a minimally invasive option for the relief of NIC complaints in a high proportion of patients. Further studies are underway to provide insight on outcomes and effectiveness compared to other decompression methods, and to develop guidance on optimal patient selection.

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Section: Discussionmentioning

confidence: 74%

Clinical evaluation of the preliminary safety and effectiveness of a minimally invasive interspinous process device APERIUS® in degenerative lumbar spinal stenosis with symptomatic neurogenic intermittent claudication

et al. 2012

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“…[4][5][6][7] Rare complications, including stress fracture of the posterior facet, erosion of the spinous process, and the sandwich phenomenon in doublelevel surgery, have also been reported. [8][9][10] In the current case, spontaneous fusion occurred because of heterotopic ossification formation in the interspinous space after the placement of an interspinous device, which, to the authors' knowledge, has not been previously reported. Although no obvious clinical symptoms were observed in the current patient, heterotopic ossification could be a potential complication in the mid and long term because it may hamper the motion preservation.…”

Section: E1823mentioning

confidence: 65%

Fusion After Interspinous Device Placement

Tian¹,

Zhang²,

Wu³

et al. 2012

Orthopedics

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Lumbar interspinous devices are intended to unload the facet joints, restore foraminal height, lower intradisk pressure, and provide motion-preserving stabilization. They are an alternative treatment for patients with spinal degeneration and have increased in popularity in recent years. To the authors' knowledge, heterotopic ossification has not been previously reported around an interspinous device, and this is the first reported case of interspinous fusion after interspinous device placement.A 66-year-old man presented with a 3-year history of low back pain and a 4-month history of radiating pain down his left leg. A diagnosis was made of lumbar spinal stenosis and left disk herniation at L4-L5 after physical and imaging examinations. A dynamic interspinous device was implanted after the decompressive surgery. The patient's symptoms were relieved postoperatively. Thirty-two months later, he returned with back pain after being in a traffic accident. Lumbar radiographs showed a massive bony formation around the implant. Radiographs and a computed tomography scan 4.5 years later revealed that the implanted device segments were fused. No implant motion was seen on dynamic radiographs. Because the patient was symptom free, no interventions were performed.Heterotopic bone formation around a dynamic interspinous device may hamper motion preservation, and heterotopic ossification is a potential mid- and long-term complication.

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“…The fracture of the spinous process and mounting device has been previously reported. Reduction of space between spinous process of adjacent vertebral segments due to aging after many years, since the device was first implanted can lead to increment of stress on both spinous process and the device, increasing the chances of fractures higher 3 , 5 , 6 , 8) .…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, numerous interspinous implants have been developed since Knowles' study in 1950s 9) . However, it has been reported that the use of interspinous implants are often accompanied by postoperative complications, such as device migration, spinous process fracture and implant breakage 3 , 5 , 6) . In addition, its effectiveness and application have been questioned.…”

Section: Introductionmentioning

confidence: 99%

Finite Element Analysis of the Biomechanical Effect of Coflex™ on the Lumbar Spine

et al. 2012

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ObjectiveThe biomechanical properties of the Coflex™ (Paradigm Spine, NY, USA), a device designed to provide dynamic stabilization without lumbar fusion, have not been clearly defined. The purpose of this study was to determine the efficacy and biomechanical effect of Coflex™ using finite element model (FEM).MethodsA 3D geometric model of the L3-L5 was created by integrating computerized tomography (CT) images. Based on the geometric model, a 3D FEM was created and the Coflex™ model was incorporated into the base model. Mechanical load dependent on the postural changes and boundary conditions, were imposed to simulate various 3D physiological states. The simulation analysis included stress and strain distributions, intervertebral disc deformation, and the range of motion of the facet joint and lumbar spinous process.ResultsCoflex™ significantly restrained displacement in extension, lateral bending and compression of joint between the L4-5 as one in the experimental group was observed -1.3% of flexion, -24.5% of extension, -44.5% of lateral bending and -37.2%. The average intradiscal pressure of the L4-5 decreased by 63% and the average facet contract force of the L4-5 decreased markedly by 34% in the experimental group. A load of 120 MPa from extension was observed at the base of spinous process in the experimental group.ConclusionThe Coflex™ can be safely used for achieving functional dynamic stabilization of the lumbar vertebral column while preserving the intactness of the other components. However, the fatigue fracture of the L4 spinous process should be carefully monitored.

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Stress Fracture of Bilateral Posterior Facet After Insertion of Interspinous Implant

Abstract: Posterior facet fracture can occur as a complication of interspinous process device.

Cited by 21 publications

References 16 publications

Clinical evaluation of the preliminary safety and effectiveness of a minimally invasive interspinous process device APERIUS® in degenerative lumbar spinal stenosis with symptomatic neurogenic intermittent claudication

Clinical evaluation of the preliminary safety and effectiveness of a minimally invasive interspinous process device APERIUS® in degenerative lumbar spinal stenosis with symptomatic neurogenic intermittent claudication

Fusion After Interspinous Device Placement

Finite Element Analysis of the Biomechanical Effect of Coflex™ on the Lumbar Spine

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