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Zhu C, Xiao G. Efficacy and safety of interspinous process device compared with alone decompression for lumbar spinal stenosis: A systematic review and meta-analysis. Medicine (Baltimore) 2024; 103:e38370. [PMID: 38847722 PMCID: PMC11155552 DOI: 10.1097/md.0000000000038370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 05/03/2024] [Indexed: 06/10/2024] Open
Abstract
STUDY DESIGN Systematic review and meta-analysis. BACKGROUND Interspinous process devices (IPD) were used as a treatment in selected patients with lumbar spinal stenosis (LSS). However, the use of IPD was still debated that it had significantly higher reoperation rates compared to traditional decompression. Therefore, the purpose of the meta-analysis was to evaluate the effectiveness and safety of IPD treatment in comparison to traditional treatment. METHODS The databases were searched of PubMed, Embase and the Cochrane, Chinese National Knowledge Infrastructure, Chongqing VIP Database and Wan Fang Database up to January 2024. Relevant studies were identified by using specific eligibility criteria and data was extracted and analyzed based on primary and secondary endpoints. RESULTS A total of 13 studies were included (5 RCTs and 8 retrospective studies). There was no significant difference of Oswestey Disability Index (ODI) score in the last follow-up (MD = -3.81, 95% CI: -8.91-1.28, P = .14). There was significant difference of Visual Analog Scale (VAS) back pain scoring in the last follow-up (MD = -1.59, 95% CI: -3.09--0.09, P = .04), but there existed no significant difference of leg pain in the last follow-up (MD = -2.35, 95% CI: -6.15-1.45, P = .23). What's more, operation time, bleeding loss, total complications and reoperation rate had no significant difference. However, IPD had higher device problems (odds ratio [OR] = 9.00, 95% CI: 2.39-33.91, P = .001) and lesser dural tears (OR = 0.32, 95% CI: 0.15-0.67, P = .002) compared to traditional decompression. CONCLUSION Although IPD had lower back pain score and lower dural tears compared with traditional decompression, current evidence indicated no superiority for patient-reported outcomes for IPD compared with alone decompression treatment. However, these findings needed to be verified in further by multicenter, double-blind and large sample RCTs.
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Affiliation(s)
- Changjiu Zhu
- Department of Orthopedics, Sichuan Provincial People’s Hospital, Chengdu, China
| | - Guiling Xiao
- Department of Orthopedics, Sichuan Provincial People’s Hospital, Chengdu, China
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Zhao G, Jiang Z, Chen E, Ma T, Wu J, Song C, Li W. Biomechanical investigation of a customized interspinous spacer system in the treatment of degenerative disc diseases: A finite element analysis. Clin Biomech (Bristol, Avon) 2024; 116:106270. [PMID: 38776646 DOI: 10.1016/j.clinbiomech.2024.106270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 05/15/2024] [Accepted: 05/17/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND A novel interspinous fixation system based on anatomical parameters and incorporating transfacetopedicular screws, was developed to treat degenerative disc diseases. The biomechanical characteristics of the novel system were evaluated using finite element analysis in comparison to other classical interspinous spacers. METHODS The L1-S1 lumbar spine finite element models were surgically implanted with the novel system, Coflex and DIAM devices at the L4/L5 segment to assess the range of motion, the pression distribution of intervertebral disc, the peak stresses on the spinous process and implant during various motions. FINDINGS Range of motions of the L4/L5 surgical segment were reduced by 29.13%, 61.27%, 77.35%, 33.33%, and the peak stresses of intervertebral disc were decreased by 36.82%, 67.31%, 73.00%, 69.57% for the novel system in flexion, extension, lateral bending, and axial rotation when compared with the Coflex, and they were declined by 34.53%, 57.86%, 75.81%, 25.21%; 36.22%, 67.31%, 75.01%, 71.40% compared with DIAM. The maximum stresses of the spinous process were 29.93 MPa, 24.66 MPa, 14.45 MPa, 24.37 MPa in the novel system, and those of Coflex and DIAM were 165.3 MPa, 109 MPa, 84.79 MPa, 47.66 MPa and 52.59 MPa, 48.78 MPa, 50.27 MPa, 44.16 MPa during the same condition. INTERPRETATION Compared to other interspinous spacer devices, the novel interspinous fixation system demonstrated excellent stability, effectively distributing load on the intervertebral disc, and reducing the risk of spinous process fractures. The personalized design of the novel interspinous fixation system could be a viable option for treating degenerative disc diseases.
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Affiliation(s)
- Gaiping Zhao
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, PR China.
| | - Zhehua Jiang
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, PR China
| | - Eryun Chen
- School of Energy and Power Engineering, University of Shanghai for Science and Technology, Shanghai 200093, PR China
| | - Tong Ma
- Department of Bone and Joint Surgery, Yangpu Hospital, School of Medicine, Tongji University, Shanghai 200090, China.
| | - Jie Wu
- Key Laboratory of Hydrodynamics, School of Naval Architecture, Ocean and Civil Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Chengli Song
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, PR China
| | - Weiqi Li
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, PR China
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Tan H, Yamamoto EA, Smith S, Yoo J, Kark J, Lin C, Orina J, Philipp T, Ross DA, Wright C, Wright J, Ryu WHA. Characterizing utilization patterns and reoperation risk factors of interspinous process devices: analysis of a national claims database. PAIN MEDICINE (MALDEN, MASS.) 2024; 25:283-290. [PMID: 38065695 DOI: 10.1093/pm/pnad159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/13/2023] [Accepted: 11/21/2023] [Indexed: 04/04/2024]
Abstract
INTRODUCTION Interspinous process devices (IPDs) were developed as minimally invasive alternatives to open decompression surgery for spinal stenosis. However, given high treatment failure and reoperation rates, there has been minimal adoption by spine surgeons. This study leveraged a national claims database to characterize national IPD usage patterns and postoperative outcomes after IPD implantation. METHOD Using the PearlDiver database, we identified all patients who underwent 1- or 2-level IPD implantation between 2010 and 2018. Univariate and multivariable logistic regression was performed to identify predictors of the number of IPD levels implanted and reoperation up to 3 years after the index surgery. Right-censored Kaplan-Meier curves were plotted for duration of reoperation-free survival and compared with log-rank tests. RESULTS Patients (n = 4865) received 1-level (n = 3246) or 2-level (n = 1619) IPDs. Patients who were older (adjusted odds ratio [aOR] 1.02, 95% confidence interval [CI] 1.01-1.03, P < .001), male (aOR 1.31, 95% CI 116-1.50, P < .001), and obese (aOR 1.19, 95% CI 1.05-1.36, P < .01) were significantly more likely to receive a 2-level IPD than to receive a 1-level IPD. The 3-year reoperation rate was 9.3% of patients when mortality was accounted for during the follow-up period. Older age decreased (aOR 0.97, 95% CI 0.97-0.99, P = .0039) likelihood of reoperation, whereas 1-level IPD (aOR 1.37, 95% CI 1.01-1.89, P = .048), Charlson Comorbidity Index (aOR 1.07, 95% CI 1.01-1.14, P = .018), and performing concomitant open decompression increased the likelihood of reoperation (aOR 1.68, 95% CI 1.35-2.09, P = .0014). CONCLUSION Compared with 1-level IPDs, 2-level IPDs were implanted more frequently in older, male, and obese patients. The 3-year reoperation rate was 9.3%. Concomitant open decompression with IPD placement was identified as a significant risk factor for subsequent reoperation and warrants future investigation.
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Affiliation(s)
- Hao Tan
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR 97239, United States
| | - Erin A Yamamoto
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR 97239, United States
| | - Spencer Smith
- Department of Orthopedics and Rehabilitation, Oregon Health & Science University, Portland, OR 97239, United States
| | - Jung Yoo
- Department of Orthopedics and Rehabilitation, Oregon Health & Science University, Portland, OR 97239, United States
| | - Jonathan Kark
- Department of Orthopedics and Rehabilitation, Oregon Health & Science University, Portland, OR 97239, United States
| | - Clifford Lin
- Department of Orthopedics and Rehabilitation, Oregon Health & Science University, Portland, OR 97239, United States
| | - Josiah Orina
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR 97239, United States
| | - Travis Philipp
- Department of Orthopedics and Rehabilitation, Oregon Health & Science University, Portland, OR 97239, United States
| | - Donald A Ross
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR 97239, United States
| | - Christina Wright
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR 97239, United States
| | - James Wright
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR 97239, United States
| | - Won Hyung A Ryu
- Department of Neurological Surgery, Oregon Health & Science University, Portland, OR 97239, United States
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Zhang S, Zhang Y, Huang L, Zhang S, Lu C, Liu Z, Kang C, Wang Z. Oblique lateral interbody fusion with internal fixations in the treatment for cross-segment degenerative lumbar spine disease (L2-3 and L4-5) finite element analysis. Sci Rep 2023; 13:17116. [PMID: 37816744 PMCID: PMC10564781 DOI: 10.1038/s41598-023-43399-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 09/22/2023] [Indexed: 10/12/2023] Open
Abstract
Multi-segmental lumbar degenerative disease, including intersegmental disc degeneration, is found in clinical practice. Controversy still exists regarding the treatment for cross-segment degeneration. Oblique Lateral Interbody Fusion (OLIF) with several internal fixations was used to treat cross-segment lumbar degenerative disease. A whole lumbar spine model was extracted from CT images of the whole lumbar spine of patients with lumbar degeneration. The L2-3 and L4-5 intervertebral spaces were fused with OLIF using modeling software, the Pedicle screws were performed on L2-3 and L4-5, and different internal fixations were performed on L3-4 in Finite Element (FE) software. Among the six 10 Nm moments of different directions, the L3-4 no surgery (NS) group had the relatively largest Range of Motion (ROM) in the whole lumbar spine, while the L2-5 Long segmental fixation (LSF)group had the smallest ROM and the other groups had similar ROM. The ROM in the L1-2 and L5-S1 was relatively close in the six group models, and the articular cartilage stress and disc stress on the L1-2 and L5-S1 were relatively close. In contrast, the L3-4 ROM differed relatively greatly, with the LSF ROM the smallest and the NS ROM the largest, and the L3-4 Coflex (Coflex) group more active than the L3-4 Bacfuse (Bacfuse) group and the L3-4 translaminar facet screw fixation (TFSF) group. The stress on the articular cartilage and disc at L3-4 was relatively greater in the NS disc and articular cartilage, and greater in the Coflex group than in the Bacfuse and TFSF groups, with the greatest stress on the internal fixation in the TFSF group, followed by the Coflex group, and relatively similar stress in the Bacfuse, LSF, and NS groups. In the TFSF group, the stress on the internal fixation was greater than the yield strength among different directional moments of 10 Nm, which means it is unsuitable to be an internal fixation. The LSF group had the greatest overall ROM, which may lead to postoperative low back discomfort. The NS group has the greatest overall ROM, but its increased stress on the L3-4 disc and articular cartilage may lead to accelerated degeneration of the L3-4 disc and articular cartilage. The Coflex and Bacfuse groups had a reduced L3-4 ROM but a greater stress on disc compared to the LSF group, which may lead to disc degeneration in the long term. However, their stress on the articular cartilage was relatively low. Coflex and Bacfuse can still be considered better surgical options.
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Affiliation(s)
- Shuyi Zhang
- Department of Orthopedics, Fuzhou Second Hospital, Fuzhou, 350007, Fujian, China
- Department of Spine Surgery, Affiliated Hospital of Chengde Medical College, Chengde, 067000, Hebei, China
| | - Yilong Zhang
- Department of Spine Surgery, Affiliated Hospital of Chengde Medical College, Chengde, 067000, Hebei, China
| | - Licai Huang
- Department of Orthopedics, Fuzhou Second Hospital, Fuzhou, 350007, Fujian, China
| | - Shuao Zhang
- School of Civil Engineering, Lanzhou University of Technology, Lanzhou, 730000, Gansu, China
| | - Chenshui Lu
- Department of Foreign Languages, Fu Zhou University, Fuzhou, 350100, Fujian, China
| | - Zhengpeng Liu
- Department of Spine Surgery, Affiliated Hospital of Chengde Medical College, Chengde, 067000, Hebei, China
| | - Chan Kang
- Department of Orthopedics, Chungnam National University Hospital, Daejeon, 35015, Republic of Korea
| | - Zhao Wang
- Department of Orthopedics, Chungnam National University Hospital, Daejeon, 35015, Republic of Korea.
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Kaya Ayvaz D, Kervancıoğlu P, Bahşi A, Bahşi İ. A Radiological Evaluation of Lumbar Spinous Processes and Interspinous Spaces, Including Clinical Implications. Cureus 2021; 13:e19454. [PMID: 34912602 PMCID: PMC8664751 DOI: 10.7759/cureus.19454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2021] [Indexed: 11/16/2022] Open
Abstract
Background and objective The aim of this study was the examination of morphometry of the spinous process (SP) and interspinous space (ISS) of the lumbar region to help provide a basis for the design and implantation of interspinous devices. Methods Between 2017 and 2019, 215 individuals underwent magnetic resonance imaging of the lumbar region for various reasons. No pathology was detected in these images, and the participants' age, height, and weight information when available were included in the study. From these images, the height and length of the SP and ISS in the lumbar region were noted. The heights of the SP and ISS were measured at three levels as anterior, middle, and posterior (respectively, anterior height of the spinous process [AHSP], middle height of the spinous process [MHSP], as well as posterior height of the spinous process [PHSP] for the height of SP, and anterior ISS, middle ISS and posterior ISS for the height of ISS). All measurements were compared according to the gender, age, weight, height, and body mass index of the individuals. Results The level with the lowest SP height and length was L5 vertebra. The ISS height and length were lowest at L4-L5. In addition, we observed a statistically significant difference at multiple levels with age, weight, height, and body mass index of the reference ranges. Conclusion We think that these changes should be considered when designing and implanting interspinous devices. Since there are few studies examining all these correlations, we think that the results of this study will make a unique contribution to the literature.
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Current concepts of spondylosis and posterior spinal motion preservation for radiologists. Skeletal Radiol 2021; 50:2169-2184. [PMID: 34131792 DOI: 10.1007/s00256-021-03840-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/03/2021] [Accepted: 06/03/2021] [Indexed: 02/02/2023]
Abstract
Spinal fusion is performed to eliminate motion at a degenerated or unstable segment. However, this is associated with loss of motion at the fused levels and increased stress on adjacent levels. Motion-preserving implants have been designed in effort to mitigate the limitations of fusion. This review will focus on posterior spinal motion-preserving technologies. In the cervical spine, laminoplasty is a posterior motion-preserving procedure used in the management of myelopathy/cord compression. In the lumbar spine, motion-sparing systems include interspinous process devices (also referred to as interspinous process spacers or distraction devices), posterior dynamic stabilization devices (also referred to as pedicle screw/rod fixation-based systems), and posterior element replacement systems (also referred to as total facet replacement devices). Knowledge of the intended physiologic purpose, hardware utilized, and complications is important in the assessment of imaging in those who have undergone posterior motion preservation procedures.
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Faulkner JE, Khalifeh K, Hara J, Ozgur B. Interspinous Process (ISP) Devices in Comparison to the Use of Traditional Posterior Spinal Instrumentation. Cureus 2021; 13:e13886. [PMID: 33868850 PMCID: PMC8043769 DOI: 10.7759/cureus.13886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2021] [Indexed: 11/05/2022] Open
Abstract
A systematic literature review was conducted on studies comparing interspinous process (ISP) devices to traditional methods of posterior spinal instrumentation (pedicle screw-rod construct), in terms of indications of use, complications, pain assessment, estimated blood loss, length of hospital stay, reoperation rates, and return to work. The objective was to analyze, evaluate and summarize the current published literature on the proposed efficacy and clinical and surgical long-term outcomes of the ISP device in comparison to the traditional posterior spinal instrumentation (pedicle screw-rod construct). The ISP device is a minimally invasive and less disruptive alternative to traditional methods of posterior spinal instrumentation (pedicle screw-rod construct). However, very few published literature studies to date have reported the comparison of ISPs in terms of efficacy and clinical and surgical outcomes, to traditional posterior spinal instrumentation. A systematic literature review was performed in PubMed and Google Scholar to evaluate the results of published research that meet the defined inclusion and exclusion criteria and to analyze clinical indications and surgical outcomes of the ISP device compared to traditional methods of posterior spinal instrumentation (pedicle screw-rod construct). Inclusion criteria included keywords such as "ISP device, ISP, posterior spinal instrumentation, pedicle screw fixation, bilateral pedicle screws, interbody fusion with posterior spinal instrumentation, lumbar spinal stenosis, and posterior lumbar stability." No exclusion criteria keywords were included in this literature review. ISPs provide a high degree of spinal stability in multiple planes, including a decreased range of motion restriction in flexion-extension, and comparable results to bilateral pedicle screw (BPS) in axial rotation. The use of the ISP device in adjunct with an interbody fusion, ensures less estimated operative blood loss (EBL), shorter operative time, less bony exposure without the need for extensive soft tissue or muscle retraction, a decrease in the rate of pseudoarthrosis, and a shorter length of hospital stay (LOHS) when compared to the traditional posterior instrumentation (pedicle screw-rod construct). Based on the various published literature reviews noted throughout this research paper, it is safe to conclude, that an ISP device that is accompanied by interbody fusion, including posterior approaches posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion (TLIF); anterior approaches such as anterior interbody fusion (ALIF), and lateral approaches including direct lateral interbody fusion (DLIF), lateral lumbar interbody fusion (LLIF), extreme lateral interbody fusion (XLIF), is considered a credible and an effective minimally invasive option for the treatment of mild to moderate lumbar stenosis and stable low-grade spondylolisthesis (less than two) when compared to the traditional posterior spinal instrumentation of a pedicle screw-rod construct. Surgeons that are relatively new to the ISP technologies for spinal instrumentation would likely benefit from more clinical and surgical evidence of safety and efficacy in published peer-reviewed medical literature. Further clinical trials are needed to manifest the efficacy of ISPs regarding postoperative outcomes when compared to traditional posterior instrumentation techniques (pedicle screw-rod construct) with adjunct interbody fusions.
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Affiliation(s)
- Jordan E Faulkner
- Neurological Surgery, Hoag Memorial Hospital, Newport Beach, USA
- Neurosurgery, ONE Brain and Spine Center, Irvine, USA
| | | | - Junko Hara
- Neurosurgery, Pickup Family Neurosciences Institute, Newport Beach, USA
| | - Burak Ozgur
- Neurosurgery, Hoag Memorial Hospital, Newport Beach, USA
- Neurosurgery, Pickup Family Neurosciences Institute, Newport Beach, USA
- Neurosurgery, ONE Brain and Spine Center, Irvine, USA
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Bae IS, Bak KH, Chun HJ, Ryu JI, Park SJ, Lee SJ. Biomechanical analysis of a newly developed interspinous process device conjunction with interbody cage based on a finite element model. PLoS One 2020; 15:e0243771. [PMID: 33306706 PMCID: PMC7732105 DOI: 10.1371/journal.pone.0243771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 11/27/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose This study aimed to investigate the biomechanical effects of a newly developed interspinous process device (IPD), called TAU. This device was compared with another IPD (SPIRE) and the pedicle screw fixation (PSF) technique at the surgical and adjacent levels of the lumbar spine. Materials and methods A three-dimensional finite element model analysis of the L1-S1 segments was performed to assess the biomechanical effects of the proposed IPD combined with an interbody cage. Three surgical models—two IPD models (TAU and SPIRE) and one PSF model—were developed. The biomechanical effects, such as range of motion (ROM), intradiscal pressure (IDP), disc stress, and facet loads during extension were analyzed at surgical (L3-L4) and adjacent levels (L2-L3 and L4-L5). The study analyzed biomechanical parameters assuming that the implants were perfectly fused with the lumbar spine. Results The TAU model resulted in a 45%, 49%, 65%, and 51% decrease in the ROM at the surgical level in flexion, extension, lateral bending, and axial rotation, respectively, when compared to the intact model. Compared to the SPIRE model, TAU demonstrated advantages in stabilizing the surgical level, in all directions. In addition, the TAU model increased IDP at the L2-L3 and L4-L5 levels by 118.0% and 78.5% in flexion, 92.6% and 65.5% in extension, 84.4% and 82.3% in lateral bending, and 125.8% and 218.8% in axial rotation, respectively. Further, the TAU model exhibited less compensation at adjacent levels than the PSF model in terms of ROM, IDP, disc stress, and facet loads, which may lower the incidence of the adjacent segment disease (ASD). Conclusion The TAU model demonstrated more stabilization at the surgical level than SPIRE but less stabilization than the PSF model. Further, the TAU model demonstrated less compensation at adjacent levels than the PSF model, which may lower the incidence of ASD in the long term. The TAU device can be used as an alternative system for treating degenerative lumbar disease while maintaining the physiological properties of the lumbar spine and minimizing the degeneration of adjacent segments.
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Affiliation(s)
- In-Suk Bae
- Department of Neurosurgery, Eulji University Eulji Hospital, Nowon-gu, Republic of Korea
| | - Koang-Hum Bak
- Department of Neurosurgery, Hanyang University Medical Center, Seongdong-gu, Seoul, Republic of Korea
- * E-mail:
| | - Hyoung-Joon Chun
- Department of Neurosurgery, Hanyang University Medical Center, Seongdong-gu, Seoul, Republic of Korea
| | - Je Il Ryu
- Department of Neurosurgery, Hanyang University Guri Hospital, Guri, Gyonggi-do, Republic of Korea
| | - Sung-Jae Park
- R&D Center, GS medical Co, Ltd, Cheongju-si, Chungcheongbuk-do, Republic of Korea
| | - Sung-Jae Lee
- Department of Biomedical Engineering, College of Biomedical Science& Engineering, Inje University, Gimhae-si, Gyeongsangnam-do, Republic of Korea
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Yin JY, Guo LX. Biomechanical analysis of lumbar spine with interbody fusion surgery and U-shaped lumbar interspinous spacers. Comput Methods Biomech Biomed Engin 2020; 24:1-11. [PMID: 33241697 DOI: 10.1080/10255842.2020.1851368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/11/2020] [Accepted: 11/11/2020] [Indexed: 10/22/2022]
Abstract
Previous research indicates whole-body vibration may lead to low back pain. The aim of this study is assessing the dynamic characteristics of a lumbar spine with Coflex and Coflex-F (commercial implants used as lumbar interspinous spacers) and effect of lumbar interbody fusion surgery. A transient dynamic analysis is performed on three numerical lumbar spine models under the loading condition of a vertical sinusoidal force of ±40 N with a compressive follower preload of 400 N. Also, Coflex-F model with and without interbody fusion surgery is analyzed under the same loading condition. The results show that the maximum value and vibration amplitude of von Mises stress in annulus ground substance (AGS) and intradiscal pressure (IDP) at implanted segment decrease from healthy model to Coflex model, and Coflex-F model. By contrast, for adjacent segments the maximum value of implanted models are larger than that of healthy model. The maximum value of endplates with and without cage are 2.44 MPa and 1.73 MPa (L4 inferior endplate), 1.94 MPa and 1.42 MPa (L5 superior endplate), respectively. The vibration amplitude of Coflex-F model with fusion surgery is smaller than that without fusion surgery. Coflex and Coflex-F not only protect implanted segment but also have a negative effect on adjacent segments. Inserting cage for Coflex-F model can absorb vibration energy at adjacent segments.
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Affiliation(s)
- Jia-Yu Yin
- School of Mechanical Engineering and Automation, Northeastern University, Shenyang, China
| | - Li-Xin Guo
- School of Mechanical Engineering and Automation, Northeastern University, Shenyang, China
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Martínez CR, Lewandrowski KU, Rugeles Ortíz JG, Alonso Cuéllar GO, Ramírez León JF. Transforaminal Endoscopic Discectomy Combined With an Interspinous Process Distraction System for Spinal Stenosis. Int J Spine Surg 2020; 14:S4-S12. [PMID: 33122183 DOI: 10.14444/7121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The combination of the percutaneous transforaminal endoscopic decompression (PTED) with an interspinous process distraction system (IPS) may offer additional benefit in the treatment of spinal stenosis in patients who have failed nonsurgical treatment. METHODS We retrospectively reviewed the medical records of 33 patients diagnosed with lumbar stenosis and radiculopathy and treated them with transforaminal endoscopic lumbar decompression between 2013 and 2017. Primary outcome measures were modified Macnab as well as preoperative and postoperative visual analog scale (VAS) criteria and the Oswestry Disability Index (ODI). Only patients with a minimum follow-up of 2 years were included. RESULTS A total of 28 patients were treated with a combination of PTED and percutaneous IPS (group A), and 5 patients were treated with PTED and mini-open IPS (group B). In group A patients, there was a 4.48 reduction in the VAS score. The ODI changed from 50.25 preoperatively to 18.2 postoperatively, and excellent and good Macnab outcomes were obtained in 78% of patients. In group B patients, the mean VAS reduction was 5.2 points. The ODI changed from 44.34 preoperatively to 14.62 postoperatively, and 80% of group B patients achieved excellent and good Macnab outcomes. No complications related to PTED or IPS were observed throughout the 2-year follow-up. CONCLUSIONS The addition of IPS to the PTED procedure in select patients may offer additional benefits to patients being treated for lumbar lateral stenosis and foraminal stenosis with low-grade spondylolisthesis. LEVEL OF EVIDENCE 3. CLINICAL RELEVANCE Feasibility study.
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Affiliation(s)
- Carolina Ramírez Martínez
- Centro de Columna-Cirugía Mínima Invasiva, Bogotá, Colombia.,Clínica Reina Sofía-Clínica Colsanitas, Bogotá, Colombia
| | - Kai-Uwe Lewandrowski
- Fundación Universitaria Sanitas, Bogotá, Colombia.,Center for Advanced Spine Care of Southern Arizona, Surgical Institute of Tucson, Tucson, Arizona
| | - José Gabriel Rugeles Ortíz
- Centro de Columna-Cirugía Mínima Invasiva, Bogotá, Colombia.,Clínica Reina Sofía-Clínica Colsanitas, Bogotá, Colombia.,Fundación Universitaria Sanitas, Bogotá, Colombia
| | - Gabriel Oswaldo Alonso Cuéllar
- Centro de Columna-Cirugía Mínima Invasiva, Bogotá, Colombia.,Clínica Reina Sofía-Clínica Colsanitas, Bogotá, Colombia.,Fundación Universitaria Sanitas, Bogotá, Colombia
| | - Jorge Felipe Ramírez León
- Centro de Columna-Cirugía Mínima Invasiva, Bogotá, Colombia.,Clínica Reina Sofía-Clínica Colsanitas, Bogotá, Colombia.,Fundación Universitaria Sanitas, Bogotá, Colombia
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Goel A, Ranjan S, Shah A, Patil A, Vutha R. Lumbar canal stenosis: analyzing the role of stabilization and the futility of decompression as treatment. Neurosurg Focus 2020; 46:E7. [PMID: 31042662 DOI: 10.3171/2019.2.focus18726] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 02/06/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThe authors report their current experience with their previously published novel form of treatment in 70 cases of lumbar canal stenosis. The treatment consisted of only fixation of the spinal segments by the transarticular screw fixation technique. No bone, ligament, osteophyte, or disc resection was done for spinal canal and neural foraminal decompression. The proposed treatment is based on the concept that vertical instability that results in telescoping of the facets on physical activity forms the nodal point of pathogenesis of lumbar canal stenosis.METHODSDuring the period June 2014 to May 2018, 70 patients presenting with the classically described symptoms of lumbar canal stenosis were treated surgically by only fixation of involved spinal segments. Apart from clinical and radiological guides, instability was diagnosed on the basis of physical observation of the status of articulation by direct manipulation of bones of the region. The operation involved transarticular insertion of 2 or 3 screws for each articulation. The Oswestry Disability Index and visual analog scale were used to assess the patients before and after surgery and at follow-up. Additionally, a personalized patient satisfaction score was used to assess the outcome of surgery.RESULTSClinical symptomatic recovery was observed in all patients in the immediate postoperative period. During the average follow-up period, 100% of patients had varying degrees of symptomatic relief. The patient satisfaction score suggested that all patients were very satisfied with the surgical procedure. The transarticular fixation technique provided strong spinal segment fixation and a reliable ground for bone arthrodesis. No patient needed any additional modality of treatment or reoperation for recurrence of symptoms.CONCLUSIONSSpinal instability is the nodal point of pathogenesis of spinal degeneration-related lumbar canal stenosis. Only fixation of the involved spinal segments is necessary-decompression by bone or soft-tissue resection is not necessary.
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Affiliation(s)
- Atul Goel
- 1Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Parel, Mumbai; and.,2Lilavati Hospital and Research Centre, Bandra, Mumbai, India
| | - Shashi Ranjan
- 1Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Parel, Mumbai; and
| | - Abhidha Shah
- 1Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Parel, Mumbai; and
| | - Abhinandan Patil
- 1Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Parel, Mumbai; and
| | - Ravikiran Vutha
- 1Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Parel, Mumbai; and
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Casagrande J, Agosti E, Veiceschi P. How I do it: step-by-step BacJac™ posterior interspinous spacer placement. Acta Neurochir (Wien) 2020; 162:937-941. [PMID: 32006187 DOI: 10.1007/s00701-020-04240-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 01/22/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND BacJac™ is a posterior interspinous spacer for selected cases of degenerative lumbar spine diseases. It blocks the metameric vertebral segment in terminal extension, restoring foraminal heights. METHODS The authors provide a detailed step-by-step description of the surgical technique, shedding light on surgical tips and pitfalls of this procedure. An accurate pre-operative patient selection is analyzed, defining meticulously surgical indications. A high-quality video of the surgical procedure is provided. CONCLUSION BacJac™ interspinous device allows a safe, mini-invasive, and effective treatment of selected cases of degenerative lumbar spine disease.
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Affiliation(s)
- J Casagrande
- Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - E Agosti
- Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
| | - P Veiceschi
- Neurosurgery, Department of Biotechnology and Life Sciences, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
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Deer TR, Sayed D, Malinowski MN, Rowe JJ, Jameson JB, Liang K, Sclafani JA. A Review of Emerging Evidence for Utilization of a Percutaneous Interspinous Process Decompression Device to Treat Symptomatic Lumbar Adjacent-Segment Degeneration. PAIN MEDICINE (MALDEN, MASS.) 2019; 20:S9-S13. [PMID: 31808531 PMCID: PMC7182911 DOI: 10.1093/pm/pnz247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Postlaminectomy syndrome diagnoses secondary to adjacent segment degeneration are a substantial and rising cause of morbidity in the United States. Emerging spinal cord neuromodulation technologies have produced successful outcomes for postlaminectomy neuropathic pain but are less effective in treating neurogenic claudication secondary to recurrent lumbar stenosis. Percutaneous interspinous process decompression systems can be used as a salvage treatment modality for persistent structural neurogenic claudication in postlaminectomy syndrome or after spinal cord stimulator implantation. METHODS This paper is a review of emerging evidence for efficacious utilization of percutaneous interspinous process decompression. RESULTS A recent pragmatic trial of subjects who underwent percutaneous interspinous process decompression for lumbar stenosis with intermittent neurogenic claudication reported that 63% (26/41) maintained minimal clinically important improvement in visual analog scale (VAS) leg pain, 61% (25/41) in VAS back pain, 78% (32/41) in function objective values, and 88% (36/41) reported satisfaction with treatment at 12 months postop. All subjects in a small case series of seven individuals with postlaminectomy adjacent-segment disease reported postoperative satisfaction scores of 3 or 4 on a 0-4 scale and were also able to decrease or wean completely off controlled pain medications. In another study, there was a significant decrease in average leg pain (60% improvement, P < 0.0001, N = 25) and axial low back pain (58% improvement, P < 0.0001, N = 25) in patients who underwent one- or two-level percutaneous interspinous process decompression as a rescue treatment for reemerging neurogenic claudication after spinal cord stimulator implantation. CONCLUSIONS The spine often is a focus of progressive disease. Furthermore, mechanical changes associated with spinal instrumentation can lead to additional disease at adjacent levels. Many individuals will present with symptomatic neurogenic claudication recalcitrant to multimodal management strategies, including even the most sophisticated neuromodulation technologies. Implementation of salvage percutaneous interspinus process decompression implantation in cases of adjacent segment degeneration or incomplete spinal cord stimulation can decompress structural causes of neurogenic claudication while sparing the patient from more invasive surgical reoperation techniques.
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Affiliation(s)
- Timothy R Deer
- Department of Anesthesiology, West Virginia School of Medicine, Morgantown, West Virginia
| | - Dawood Sayed
- Department of Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas
| | - Mark N Malinowski
- Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio
| | | | | | - Kevin Liang
- Milestone Research Organization, San Diego, California
| | - Joseph A Sclafani
- Milestone Research Organization, San Diego, California
- Apex Pain and Wellness, Foster City, California, USA
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15
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Deer TR, Grider JS, Pope JE, Falowski S, Lamer TJ, Calodney A, Provenzano DA, Sayed D, Lee E, Wahezi SE, Kim C, Hunter C, Gupta M, Benyamin R, Chopko B, Demesmin D, Diwan S, Gharibo C, Kapural L, Kloth D, Klagges BD, Harned M, Simopoulos T, McJunkin T, Carlson JD, Rosenquist RW, Lubenow TR, Mekhail N. The MIST Guidelines: The Lumbar Spinal Stenosis Consensus Group Guidelines for Minimally Invasive Spine Treatment. Pain Pract 2018; 19:250-274. [PMID: 30369003 DOI: 10.1111/papr.12744] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 10/11/2018] [Accepted: 10/18/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Lumbar spinal stenosis (LSS) can lead to compression of neural elements and manifest as low back and leg pain. LSS has traditionally been treated with a variety of conservative (pain medications, physical therapy, epidural spinal injections) and invasive (surgical decompression) options. Recently, several minimally invasive procedures have expanded the treatment options. METHODS The Lumbar Spinal Stenosis Consensus Group convened to evaluate the peer-reviewed literature as the basis for making minimally invasive spine treatment (MIST) recommendations. Eleven consensus points were clearly defined with evidence strength, recommendation grade, and consensus level using U.S. Preventive Services Task Force criteria. The Consensus Group also created a treatment algorithm. Literature searches yielded 9 studies (2 randomized controlled trials [RCTs]; 7 observational studies, 4 prospective and 3 retrospective) of minimally invasive spine treatments, and 1 RCT for spacers. RESULTS The LSS treatment choice is dependent on the degree of stenosis; spinal or anatomic level; architecture of the stenosis; severity of the symptoms; failed, past, less invasive treatments; previous fusions or other open surgical approaches; and patient comorbidities. There is Level I evidence for percutaneous image-guided lumbar decompression as superior to lumbar epidural steroid injection, and 1 RCT supported spacer use in a noninferiority study comparing 2 spacer products currently available. CONCLUSIONS MISTs should be used in a judicious and algorithmic fashion to treat LSS, based on the evidence of efficacy and safety in the peer-reviewed literature. The MIST Consensus Group recommend that these procedures be used in a multimodal fashion as part of an evidence-based decision algorithm.
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Affiliation(s)
- Timothy R Deer
- Center for Pain Relief, Charleston, West Virginia, U.S.A
| | - Jay S Grider
- UKHealthCare Pain Services, Department of Anesthesiology, University of Kentucky College of Medicine, Lexington, Kentucky, U.S.A
| | - Jason E Pope
- Evolve Restorative Clinic, Santa Rosa, California, U.S.A
| | - Steven Falowski
- Functional Neurosurgery, St. Lukes University Health Network, Bethlehem, Pennsylvania, U.S.A
| | - Tim J Lamer
- Division of Pain Medicine, Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, U.S.A
| | | | - David A Provenzano
- Pain Diagnostics and Interventional Care, Sewickley, Pennsylvania, U.S.A
| | - Dawood Sayed
- University of Kansas Medical Center, Kansas City, Kansas, U.S.A
| | - Eric Lee
- Summit Pain Alliance, Sonoma, California, U.S.A
| | - Sayed E Wahezi
- Montefiore Medical Center, SUNY-Buffalo, Buffalo, New York, U.S.A
| | - Chong Kim
- Center for Pain Relief, Charleston, West Virginia, U.S.A
| | - Corey Hunter
- Ainsworth Institute of Pain Management, New York, New York, U.S.A
| | - Mayank Gupta
- Anesthesiology and Pain Medicine, HCA Midwest Health, Overland Park, Kansas, U.S.A
| | - Rasmin Benyamin
- Millennium Pain Center, Bloomington, Illinois, U.S.A.,College of Medicine, University of Illinois, Urbana-Champaign, Illinois, U.S.A
| | | | - Didier Demesmin
- Rutgers Robert Wood Johnson Medical School, Department of Pain Medicine, Saint Peter's University Hospital, New Brunswick, New Jersey, U.S.A
| | - Sudhir Diwan
- Manhattan Spine and Pain Medicine, Lenox Hill Hospital, New York, New York, U.S.A
| | - Christopher Gharibo
- Pain Medicine and Orthopedics, NYU Langone Hospitals Center, New York, New York, U.S.A
| | - Leo Kapural
- Carolina's Pain Institute at Brookstown, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A
| | - David Kloth
- Department of Anesthesiology, Danbury Hospital, Danbury, Connecticut, U.S.A
| | - Brian D Klagges
- Anesthesiology and Pain Medicine, Amoskeag Anesthesiology, Manchester, New Hampshire, U.S.A
| | - Michael Harned
- Department of Anesthesiology, University of Kentucky, Lexington, Kentucky, U.S.A
| | - Tom Simopoulos
- Department of Anesthesiology, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | | | | | | | | | - Nagy Mekhail
- Evidence-Based Pain Management Research and Education, Cleveland Clinic, Cleveland, Ohio, U.S.A
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Lin GX, Suen TK, Quillo-Olvera J, Akbary K, Hur JW, Kim E, Park EJ, Kim JS. Dimensions of the spinous process and interspinous space: a morphometric study. Surg Radiol Anat 2018; 40:1383-1390. [PMID: 30182307 DOI: 10.1007/s00276-018-2096-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 08/13/2018] [Indexed: 12/21/2022]
Abstract
PURPOSE To measure the morphological dimensions of the spinous process (SP) and interspinous space, and provide a basis for the development of interspinous devices for the Korean or East Asian populations. METHODS We retrospectively analyzed the anatomical parameters of 120 patients. The parameters included height, length, and width of SP, interspinous distance (supine, standing, and dynamic), cortical thickness of SP, and spino-laminar (S-L) angle. Correlations between measurements, age, and gender were investigated. RESULTS The largest height, length, and cortical thickness and S-L angle were noted at L3. The largest width was observed at S1. The interspinous distance decreased significantly from L2-3 to L5-S1 and was significantly larger in the supine than in standing posture for L5-S1. Cortical thickness was gradually tapered from the anterior to the posterior position. The S-L angle at L2 and L3 was similar and significantly decreased from L3 to S1. An increased trend in width with aging and a decreased trend in distance (supine) were noted. A significant increase in height, length, and distance in males compared with females was also observed. CONCLUSIONS The interspinous space is wider at the anterior, and the cortex is thicker anteriorly. Accordingly, it appears that the optimized implant position lies in the interspinous space anteriorly. The varying interspinous space with different postures and gradually narrowing with age suggest the need for caution when sizing the device. Gender differences also need to be considered when designing implantable devices.
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Affiliation(s)
- Guang-Xun Lin
- Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Tsz-King Suen
- Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Javier Quillo-Olvera
- Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kutbuddin Akbary
- Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jung-Woo Hur
- Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eun Kim
- Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Eun-Jin Park
- Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin-Sung Kim
- The Catholic Central Laboratory of Surgery (CCLS) and Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero Seocho-gu, Seoul, 06591, Republic of Korea.
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Filippiadis DK, Marcia S, Ryan A, Beall DP, Masala S, Deschamps F, Kelekis A. New Implant-Based Technologies in the Spine. Cardiovasc Intervent Radiol 2018; 41:1463-1473. [DOI: 10.1007/s00270-018-1987-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 05/15/2018] [Indexed: 11/28/2022]
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Bredow J, Löhrer L, Oppermann J, Scheyerer MJ, Sobottke R, Eysel P, Siewe J. Pathoanatomic Risk Factors for Instability and Adjacent Segment Disease in Lumbar Spine: How to Use Topping Off? BIOMED RESEARCH INTERNATIONAL 2017; 2017:2964529. [PMID: 28831392 PMCID: PMC5554995 DOI: 10.1155/2017/2964529] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 07/04/2017] [Indexed: 11/17/2022]
Abstract
PURPOSE The goal of this review is to identify criteria indicating implantation of hybrid system into lumbar spine and to evaluate general benefits of use. METHODS A systematic review of literature was performed using current randomized clinical trials, reviews, and meta-analyses. Data sources included relevant literature of human studies identified through searches of Medline Library until May 2015. RESULTS Predisposing factors for Adjacent Segment Disease (ASDi) are discussed in literature: laminar horizontalization, insufficiency of fascia thoracolumbalis, facet tropism, and facet sagittalization. Currently there is no evidence for topping off. There are only 12 studies and these have no consistent statements about use of a hybrid system for avoidance of ASDi. CONCLUSION Hybrid instrumentation of lumbar spine, either with pedicle-based technique or additional spacer, might possibly prevent ASDi from developing in previously damaged segment adjacent to a fusion. Good clinical data proving effectiveness of this new implant technique is as yet unavailable. Thus, currently one must speak of an unevaluated procedure. Various radiological classifications can assist in making a reliable decision as to whether hybrid instrumentation is an appropriate choice of therapy. Pathoanatomical conditions of facet joints and laminae as well as preservation of sagittal balance must also be considered.
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Affiliation(s)
- J. Bredow
- Center for Spinal Surgery, Schön Klinik Düsseldorf SE & Co. KG, Am Heerdter Krankenhaus 2, 40549 Düsseldorf, Germany
- Department of Orthopedic and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| | - L. Löhrer
- Center for Spinal Surgery, Schön Klinik Düsseldorf SE & Co. KG, Am Heerdter Krankenhaus 2, 40549 Düsseldorf, Germany
| | - J. Oppermann
- Department of Orthopedic and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| | - M. J. Scheyerer
- Department of Orthopedic and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| | - R. Sobottke
- Department of Orthopedics, Medical Center City Aachen GmBH, Wuerselen, Germany
| | - P. Eysel
- Department of Orthopedic and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| | - J. Siewe
- Department of Orthopedic and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
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Abstract
PURPOSE OF REVIEW Lumbar spinal stenosis has historically been treated with open decompressive surgery which is associated with significant morbidity and may give rise to various complications. Interspinous spacers (ISS) have been developed as a less invasive strategy which may serve to avoid many of these risks. The two current spacers that are FDA approved and commercially available are the Coflex and Superion devices. The goal is to review these two implants, their indications, and patient selection. RECENT FINDINGS The Coflex device has been shown to be analogous to decompression and fusion when treating moderate spinal stenosis. It provides dynamic stability after a decompression is performed, without the rigidity of pedicle-screw instrumentation. Recent results show improved outcomes in Coflex patients at 3 years of follow-up, as compared to decompression and fusion. The Superion implant is placed percutaneously in the interspinous space with minimal disruption of spinal anatomy. When compared to the X-Stop device (which is no longer available), the Superion implant shows improved outcomes at 3 years of follow-up. ISS are lesser invasive options as compared to formal decompression and fusion for the treatment of lumbar spinal stenosis.
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Affiliation(s)
- Raj J Gala
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 47 College Street, New Haven, CT, 06510, USA.
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, PO Box 208071, New Haven, CT, 06520-8071, USA.
| | - Glenn S Russo
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 47 College Street, New Haven, CT, 06510, USA
| | - Peter G Whang
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 47 College Street, New Haven, CT, 06510, USA
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Huang WM, Yu XM, Xu XD, Song RX, Yu LL, Yu XC. Posterior Lumbar Interbody Fusion with Interspinous Fastener Provides Comparable Clinical Outcome and Fusion Rate to Pedicle Screws. Orthop Surg 2017; 9:198-205. [PMID: 28544495 DOI: 10.1111/os.12328] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 02/16/2017] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To investigate the clinical feasibility and validity of interspinous fastener (ISF) for lumbar degenerative diseases. METHODS From October 2013 to March 2014, a total of 46 patients suffering from lumbar degenerative diseases underwent posterior lumbar interbody fusion (PLIF) randomly augmented by ISF or pedicle screws. The clinical outcome was primarily measured by Oswestry Disability Index (ODI) score. The minimal clinical important difference (MCID) was defined as an eight-point decrease in ODI. The second clinical outcome measurement was Japanese Orthopedic Association (JOA) score. Interbody fusion rates were evaluated by lumbar plain radiograph and computed tomography (CT) scan. Complications were also compared between groups. Statistical analyses were performed by SPSS version 13.0. Sample size calculation was performed before the study. The type I error α was set at 0.05 and the type II error β at 0.1. Based on these assumptions and adding 10% for possible drop-outs, sample size calculations indicated that a total of 46 patients were required for the study. Parametric data was compared by independent t-test and categorical variables were compared using χ2 -tests or Fisher exact tests depending on the sample size. A P-value of less than 0.05 was considered significantly statistically different. Fleiss kappa coefficients were calculated for intra-observer and inter-observer reliability. RESULTS A total of 43 patients completed the follow-up, with 22 cases in the ISF group and 21 patients in the pedicle screws group, respectively. Less intraoperative blood loss and shorter operation time were observed in the ISF group. The mean ODI significantly declined in both groups, with the ISF group's decreasing from preoperative 43.3 ± 8.2 to 21.4 ± 3.5 at 24-month follow-up and the pedicle screws group's decreasing from preoperative 42.9 ± 7.9 to 22.5 ±3.8 at 24-month follow-up, respectively. The ODI changes between groups had no statistical difference (P > 0.05). Of the 43 patients, 33 patients achieved an MCID. The bone fusion rate was 77.3% according to X-rays and 68.2% according to CT scans in the ISF group, and 81.0% according to X-rays and 76.2% according to CT scans in the pedicle screws group at the final follow-up. The intra-observer and inter-observer reliability assessed by the kappa value were 0.93 and 0.89, respectively. One patient in the pedicle screws group demonstrated screw loosening at the 6-month follow-up but was asymptomatic. One patient with spondylolisthesis in the ISF group demonstrated cage subsidence during the follow-up but also without related symptoms. CONCLUSION The less invasive ISF combined with PLIF provided comparable clinical outcome and a similar bone fusion rate to pedicle screws. The ISF could potentially serve as a new alternative for lumbar degenerative diseases.
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Affiliation(s)
- Wei-Min Huang
- Department of Orthopaedics, General Hospital of Jinan Military Commanding Region, Jinan, China
| | - Xing-Ming Yu
- Postgraduate Training Base in General Hospital of Jinan Military Command, Liaoning Medical University, Jinzhou, China
| | - Xiao-Duo Xu
- Department of Orthopaedics, General Hospital of Jinan Military Commanding Region, Jinan, China
| | - Ruo-Xian Song
- Department of Orthopaedics, General Hospital of Jinan Military Commanding Region, Jinan, China
| | - Li-Li Yu
- Department of Statistics, General Hospital of Jinan Military Commanding Region, Jinan, China
| | - Xiu-Chun Yu
- Department of Orthopaedics, General Hospital of Jinan Military Commanding Region, Jinan, China
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Fu L, Ma J, Lu B, Jia H, Zhao J, Kuang M, Feng R, Xu L, Bai H, Sun L, Wang Y, Ma X. Biomechanical effect of interspinous process distraction height after lumbar fixation surgery: An in vitro model. Proc Inst Mech Eng H 2017; 231:663-672. [PMID: 28410566 DOI: 10.1177/0954411917700446] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pedicle screw fixation may induce abnormal activity at adjacent segment and accelerate the degeneration of lumbar vertebrae. Dynamic stabilizers could provide an intermediate solution between conservative treatment and fusion surgery. Lumbar vertebral segment cephalad to instrumented fixation was the most common localization of adjacent segment degeneration. The aim of this study is to explore the use of interspinous process devices in the lumbar vertebral segment cephalad to fixation segment in changing the mechanical distribution and limiting abnormal activity of the spine. Eight specimens were tested in the following groups: intact group, instability group (bilateral facetectomy at L3-L4), fixation group (bilateral facetectomy and pedicle screw fixation at L3-L4), and hybrid fixation group (fixation at L3-L4 and simulating interspinous device implantation of 6, 8, 10, 12, 14, 16, and 18 mm at L2-L3). Range of motion, motion of vertebral body, and strain distribution change were recorded. The range of motion in extension with 16- and 18-mm hybrid constructs was significantly lower than intact, instability, and fixation groups. In flexion and lateral bending, the strain values of L4 inferior articular process with 18-mm hybrid construct have a significant difference compared with other groups. In axial rotation, under the condition of a contralateral state, the strain values of L2 superior articular process with 18-mm hybrid construct have a significant difference compared with intact and fixation groups. The strain value of the L4 inferior articular process had negative correlation with height distraction in three dimensions, except extension. A negative correlation between the strain value of the L2 superior articular process and distraction height was found in contralateral bending and contralateral axial rotation. Interspinous process devices above the fixation segment can change the mechanical distribution of the spine and limit activity in some of the segments of the spine, which may delay the degeneration of the adjacent segment.
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Affiliation(s)
- Lin Fu
- 1 General Hospital, Tianjin Medical University, Tianjin, China
| | - Jianxiong Ma
- 2 Orthopaedics Research Institute, Tianjin Hospital Heping Branch, Tianjin, China
| | - Bin Lu
- 2 Orthopaedics Research Institute, Tianjin Hospital Heping Branch, Tianjin, China
| | - Haobo Jia
- 2 Orthopaedics Research Institute, Tianjin Hospital Heping Branch, Tianjin, China
| | - Jie Zhao
- 2 Orthopaedics Research Institute, Tianjin Hospital Heping Branch, Tianjin, China
| | - Mingjie Kuang
- 2 Orthopaedics Research Institute, Tianjin Hospital Heping Branch, Tianjin, China
| | - Rui Feng
- 2 Orthopaedics Research Institute, Tianjin Hospital Heping Branch, Tianjin, China
| | - Liyan Xu
- 2 Orthopaedics Research Institute, Tianjin Hospital Heping Branch, Tianjin, China
| | - Haohao Bai
- 2 Orthopaedics Research Institute, Tianjin Hospital Heping Branch, Tianjin, China
| | - Lei Sun
- 2 Orthopaedics Research Institute, Tianjin Hospital Heping Branch, Tianjin, China
| | - Ying Wang
- 2 Orthopaedics Research Institute, Tianjin Hospital Heping Branch, Tianjin, China
| | - Xinlong Ma
- 2 Orthopaedics Research Institute, Tianjin Hospital Heping Branch, Tianjin, China
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22
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Hao Y, Liu T, Yu L, Ma C, Liu Y, Li Z, Zhang D. [Percutaneous transforaminal endoscopic discectomy combined with Coflex interspinous process dynamic reconstruction system in treatment of youth lumbar disc herniation]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2017; 31:191-196. [PMID: 29786252 PMCID: PMC8458143 DOI: 10.7507/1002-1892.201608062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 12/17/2016] [Indexed: 11/03/2022]
Abstract
Objective To evaluate the effectiveness of percutaneous transforaminal endoscopic discectomy (PTED) combined with Coflex interspinous process dynamic reconstruction system for the treatment of youth lumbar disc herniation (LDH). Methods The clinical data of 52 patients with LDH treated by PTED combined with Coflex were retrospectively analyzed between February 2013 and March 2015. The involved segments were L 4, 5 in 30 cases and L 5, S 1 in 22 cases. In 30 patients at L 4, 5 level, there were 18 males and 12 females with an average age of 25 years (range, 18-34 years) and a mean disease duration of 10 months (range, 6-16 months). In 22 patients at L 5, S 1 level, there were 10 males and 12 females with an average age of 25.5 years (range, 19-32 years) and a mean disease duration of 12 months (range, 6-18 months). The operation time and intraoperative blood loss were recorded. Oswestry disability index (ODI) and Japanese Orthpoaedic Association (JOA) score were used for effectiveness assessment. Radiograpic indexes were calculated on X-ray films before operation and final follow-up, including ventral intervertebral space height (VH), dorsal intervertebral space height (DH), intervertebral foramen height (IFH), the range of motion (ROM) of involved segment, and the ROM of upper adjacent segment. Results The operations were successfully completed in 52 patients. The operation time and intraoperative blood loss were (89.7±16.5) minutes and (42.7±11.3) mL in patients at L 4, 5 level, and were (94.6±18.2) minutes and (47.6±13.4) mL in patients at L 5, S 1 level. Incisions healed by first intention. All patients were followed up 12-18 months (mean,16 months) in patients at L 4, 5 level and 12-20 months (mean, 17 months) in patients at L 5, S 1 level. At final follow-up, ODI, and JOA score were significantly improved when compared with preoperative ones in all patients ( P<0.05). X-ray films showed no complication of Coflex loosening, spinous process fracture, or articular process fracture occurred. At final follow-up, VH, DH, and IFH were significantly improved when compared with preoperative ones in all patients ( P<0.05), and the ROM of involved segment was significantly reduced compared with preoperative one ( P<0.05), but the ROM of upper adjacent segment showed no significant difference when compared with preoperative one ( P>0.05). Conclusion PTED combined with Coflex is a safe and effective minimally invasive surgery in treating youth LDH; however, it still needs further clinical studies.
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Affiliation(s)
- Yingjie Hao
- Department of Orthopedics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou Henan, 450052,
| | - Tao Liu
- Department of Orthopedics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou Henan, 450052, P.R.China
| | - Lei Yu
- Department of Orthopedics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou Henan, 450052, P.R.China
| | - Caoyuan Ma
- Department of Orthopedics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou Henan, 450052, P.R.China
| | - Yawei Liu
- Department of Orthopedics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou Henan, 450052, P.R.China
| | - Zhilei Li
- Department of Orthopedics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou Henan, 450052, P.R.China
| | - Di Zhang
- Department of Orthopedics, the First Affiliated Hospital of Zhengzhou University, Zhengzhou Henan, 450052, P.R.China
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Interspinous process devices(IPD) alone versus decompression surgery for lumbar spinal stenosis(LSS): A systematic review and meta-analysis of randomized controlled trials. Int J Surg 2017; 39:57-64. [PMID: 28110031 DOI: 10.1016/j.ijsu.2017.01.074] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 01/13/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND and purpose: Interspinous process devices (IPD) were widely used for the treatment of lumbar spinal stenosis (LSS). However, whether IPD was superior to bony decompression was still debated. We aimed to compare the clinical outcomes of IPD to bony decompression for LSS. METHODS PubMed, Cochrane library, Cochrane Central Register of Controlled Trials (CCTR), Ovid Medline, China national knowledge internet database, Wan Fang database were searched in August.8th.2016. Studies were identified using selection criteria and analysed was performed with Review Manager Version 5.3. RESULTS Four RCTs (seven articles) were included, with 200 patients in the interspinous process devices (IPD) group and 200 patients in bony decompression (DP) group. There was no significant difference in hospital stay time (P = 0.36), VAS leg pain scores (P = 0.83), and complication rates (P = 0.20) for IPD alone versus bony decompression. However, IPD alone showed higher VAS low back pain scores (P = 0.03) and reoperation rates (P < 0.0001) between the two therapy groups. Two studies' results showed the IPD group had lower cost-effectiveness. CONCLUSIONS Although patients who received IPD may obtain several benefits in the short term, it was associated with higher costs, reoperation rates. Both IPD and bony decompression were acceptable strategies for LSS, but the risks, indications, and costs of IPD should be carefully taken into account before surgery.
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Evaluation of Coflex interspinous stabilization following decompression compared with decompression and posterior lumbar interbody fusion for the treatment of lumbar degenerative disease: A minimum 5-year follow-up study. J Clin Neurosci 2017; 35:24-29. [PMID: 27815024 DOI: 10.1016/j.jocn.2016.09.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 07/17/2016] [Accepted: 09/21/2016] [Indexed: 11/20/2022]
Abstract
Few studies have compared the clinical and radiological outcomes between Coflex interspinous stabilization and posterior lumbar interbody fusion (PLIF) for degenerative lumbar disease. We compared the at least 5-year clinical and radiological outcomes of Coflex stabilization and PLIF for lumbar degenerative disease. Eighty-seven consecutive patients with lumbar degenerative disease were retrospectively reviewed. Forty-two patients underwent decompression and Coflex interspinous stabilization (Coflex group), 45 patients underwent decompression and PLIF (PLIF group). Clinical and radiological outcomes were evaluated. Coflex subjects experienced less blood loss, shorter hospital stays and shorter operative time than PLIF (all p<0.001). Both groups demonstrated significant improvement in Oswestry Disability Index and visual analogue scale back and leg pain at each follow-up time point. The Coflex group had significantly better clinical outcomes during early follow-up. At final follow-up, the superior and inferior adjacent segments motion had no significant change in the Coflex group, while the superior adjacent segment motion increased significantly in the PLIF group. At final follow-up, the operative level motion was significantly decreased in both groups, but was greater in the Coflex group. The reoperation rate for adjacent segment disease was higher in the PLIF group, but this did not achieve statistical significance (11.1% vs. 4.8%, p=0.277). Both groups provided sustainable improved clinical outcomes for lumbar degenerative disease through at least 5-year follow-up. The Coflex group had significantly better early efficacy than the PLIF group. Coflex interspinous implantation after decompression is safe and effective for lumbar degenerative disease.
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Application of the Coflex Interlaminar Stabilization in Patients With L5/S1 Degenerative Diseases: Minimum 4-Year Follow-up. Am J Ther 2016; 23:e1813-e1818. [DOI: 10.1097/mjt.0000000000000333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cruz Ricardez JA, Romero Arroyo JAC. INTERSPINOUS SPACER IN PERSISTENT DISCOGENIC PAIN: PERCUTANEOUS APPROACH OR OPEN TECHNIQUE. COLUNA/COLUMNA 2016. [DOI: 10.1590/s1808-185120161502155246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: To compare the postoperative clinical course of placement of interspinous spacer with open technique (ISO) with percutaneous interspinous spacer (PIS). Methods: Quasi-experimental, longitudinal study of 42 patients with discogenic pain uncontrolled with analgesics, aged 35-55 years old, 21 women, and 21 men. Clinical history, location of pain, VAS scale before and after surgery, Oswestry Disability Index and Macnab modified scale at 6 months were used. Results: When performing quantitative analysis statistical significance (p = 0.0478, 0.0466, 0.0399) was demonstrated with Student's t test between the results according to VAS scale; in the qualitative analysis with the Oswestry index and Macnab modified scale it was demonstrated the hypothesis that the results is dependent of the surgical technique. Conclusions: According to the results, we can conclude that there is a statistically significant difference depending on the surgical technique used with respect to the rate of disability and functionality in daily life as well as in the improvement of pain symptoms.
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Szpalski M, Gunzburg R, Colloca CJ, Kosmopoulos V, Hegazy MA, Freeman BJC, Fabeck L. Restoring lumbar spine stiffness using an interspinous implant in an ovine model of instability. Clin Biomech (Bristol, Avon) 2016; 33:85-91. [PMID: 26963708 DOI: 10.1016/j.clinbiomech.2016.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 01/08/2016] [Accepted: 02/15/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND The objective of this study was to determine the effect of an interspinous implant on lumbar spine stability and stiffness during dorsoventral loading. METHODS Twelve Merino lambs were mechanically tested in vivo. Oscillatory (2 Hz) loads were applied to L2 under load control while displacements were monitored. Tri-axial accelerometers further quantified adjacent L3-L4 accelerations. Dorsoventral lumbar spine stiffness and L3 and L4 dorsoventral and axial displacements were determined over six trials of 20 cycles of loading. Four conditions were examined: 1) initial intact, 2) following destabilization at L3-L4, 3) following the insertion of an InSwing(®) interspinous device at L3-L4, and 4) with the implant secured with a tension band. Comparisons were performed using a one-way ANOVA with repeated measures and post-hoc Bonferroni correction. FINDINGS Compared to the intact condition, destabilization significantly decreased lumbar stiffness by 4.5% (P=.001) which was only recovered by the interspinous device with tension band. The interspinous device caused a significant 9.75% (P=.001) increase in dorsoventral stiffness from destabilization that increased 14% with the tension band added (P=.001). The tension band was responsible for decreased displacements from the intact (P=.038), instability (P=.001), and interspinous device (P=.005) conditions. Dorsoventral L3-L4 motion significantly improved with the interspinous device (P=.01) and the addition of the tension band (P=.001). No significant differences in L3-L4 intersegmental stability were noted for axial motion in the sagittal plane. INTERPRETATION This ovine model provided objective in vivo biomechanical evidence of lumbar instability and its restoration by means of an interspinous implant during dorsoventral spinal loading.
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Affiliation(s)
- Marek Szpalski
- Department of Orthopedics, Hôpitaux Iris Sud/IRIS South Teaching Hospitals, Brussels, Belgium.
| | - Robert Gunzburg
- Department of Orthopaedic Surgery, Edith Cavell Clinic Hospital, Brussels, Belgium
| | - Christopher J Colloca
- Biomechanics Laboratory, Kinesiology Program, College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - Victor Kosmopoulos
- Bone and Joint Research Center, Department of Orthopaedic Surgery, University of North Texas Health Science Center, Fort Worth, TX, USA; Department of Materials Science and Engineering, University of North Texas, Denton, TX, USA
| | | | - Brian J C Freeman
- Department of Spinal Surgery, Royal Adelaide Hospital, Adelaide, Australia; Adelaide Centre for Spinal Research, SA Pathology, Adelaide, Australia; Centre for Orthopaedic and Trauma Research, University of Adelaide, Australia
| | - Laurent Fabeck
- Department of Orthopedics, St Pierre Hospital, Brussels, Belgium
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Posterior dynamic stabilization in the lumbar spine - 24 months results of a prospective clinical and radiological study with an interspinous distraction device. BMC Musculoskelet Disord 2016; 17:90. [PMID: 26891907 PMCID: PMC4757981 DOI: 10.1186/s12891-016-0945-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 02/13/2016] [Indexed: 11/21/2022] Open
Abstract
Background Interspinous distraction devices (IDD) are due to maintain or restore intersegmental range of motion (iROM) in a controlled fashion with the aim of stabilization the affected level dynamically. The following study is the first to present clinical and radiological data with the Wallis® spacer during a follow-up of 24 months. Methods Ten patients underwent posterior dynamic stabilization (PDS) of the lumbar spine with an IDD (Wallis® spacer) and were controlled clinically and radiologically after 3, 6, 12, and 24 months in a prospective study design. Pain intensity, functional disability and life quality were assessed by use of subjective scores. Motion analyses were performed with the help of lateral functional x-rays to determine the iROM of the operated segments and total ROM (tROM) of the lumbar spine. In addition, roentgen stereophotogrammetric analysis (RSA) was used to measure the iROM of the treated levels. Results During the postoperative course pain and disability most clinical scores were significantly improved. After 24 months we observed statistically significant reduction in back pain intensity with a mean value of 6.0 on visual analog scale (VAS) before surgery and of 2.7 at the latest evaluation. The leg pain was also decreased without statistical significance from 4.7 preoperatively to 2.1 at final follow-up. The functional disability according to Oswestry Disability Index (ODI) and Roland-Morris Disability Questionnaire (RM) was decreased both with statistical significance at all examination dates with a mean value in ODI of 40.0 % before operation and of 17.3 % after 2 years and an initial mean value in RM of 55.2 and of 23.5 % after latest follow-up. After 24 months, the results of the health related quality of life score also showed much better values with only two exceptions. The iROM of the treated levels was reduced during each follow-up examination with preserved residual mobility. Directly postoperatively and after 3 and 12 months intersegmental mobility was statistically significantly decreased with an average iROM of 6.62° before operation and of 2.69° few days after surgery, of 3.79° and 3.16° 3 and 12 months later. At 6 (4.37°) and 24 (4.01°) months follow-up iROM was also but not statistically significantly reduced. The mean tROM did not change significantly during all postoperative controls. Conclusions The radiological findings support the thesis of posterior dynamic stabilization by the used implant. The positive clinical findings should be interpreted with caution because of the limited number of patients and the missing control group.
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Wang T, Fielding LC, Parikh A, Kothari M, Alamin T. Sacral spinous processes: a morphologic classification and biomechanical characterization of strength. Spine J 2015; 15:2544-51. [PMID: 26343242 DOI: 10.1016/j.spinee.2015.08.058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 07/31/2015] [Accepted: 08/25/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND There has been increasing interest in using the lumbosacral spinous processes for fixation as a less invasive alternative to transpedicular instrumentation. Alhough prior studies have described the appearance and biomechanics of lumbar spinous processes, few have evaluated the dimensions, morphology, or strength of the sacral spinous processes. PURPOSE The goals of this study were to characterize the morphology of the S1 spinous process and biomechanical strength of the S1 spinous process when loaded in a cranial direction. STUDY DESIGN This study was performed as both an analysis of radiographic data and biomechanical testing of cadaveric specimens. METHODS Lumbosacral spine radiographs and computed tomography scans of 20 patients were evaluated for visibility and morphology of the S1 spinous process. S1 spinous process length, height, and size of the L5-S1 segment were measured. Additionally, 13 cadaveric lumbosacral spinal segments were obtained for biomechanical testing and morphologic analysis. Specimens were loaded at the S1 spinous process in a cranial direction via a strap, simulating resistance to a flexion moment applied across the L5-S1 segment. Peak load to failure, displacement, and mode of failure were recorded. RESULTS The S1 spinous process was clearly visible on lateral radiographs in only 10% of patients. Mean spinous process length (anterior-posterior) was 11.6 mm while mean spinous process height (cranial-caudal) was 23.1 mm. We identified six different morphologic subtypes of the S1 spinous process: fin, lumbar type, fenestrated, fused, tubercle, and spina bifida occulta. During tension loading of the S1 spinous process in the cephalad direction, mean peak load to failure was 439N, with 92% of specimens failing by fracture through the spinous process. CONCLUSIONS This is the first study evaluating sacral spinous process morphology, visibility, and biomechanical strength for potential instrumentation. Compared with lumbar spinous processes, sacral spinous processes are smaller with more variable morphology but have similar peak load to failure. For ideal visualization of morphology and suitability for interspinous fixation,preoperative three-dimensional imaging may be a valuable tool over plain radiographs.
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Affiliation(s)
- Tim Wang
- Stanford Orthopaedic Surgery, 450 Broadway St Pavilion C 4th Floor, Redwood City, CA 94063, USA.
| | | | - Anand Parikh
- Simpirica Spine, 1680 Bayport Ave, San Carlos, CA 94070, USA
| | - Manish Kothari
- Simpirica Spine, 1680 Bayport Ave, San Carlos, CA 94070, USA
| | - Todd Alamin
- Stanford Orthopaedic Surgery, 450 Broadway St Pavilion C 4th Floor, Redwood City, CA 94063, USA; Simpirica Spine, 1680 Bayport Ave, San Carlos, CA 94070, USA
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Lee SH, Seol A, Cho TY, Kim SY, Kim DJ, Lim HM. A Systematic Review of Interspinous Dynamic Stabilization. Clin Orthop Surg 2015; 7:323-9. [PMID: 26330954 PMCID: PMC4553280 DOI: 10.4055/cios.2015.7.3.323] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2015] [Accepted: 03/28/2015] [Indexed: 11/30/2022] Open
Abstract
Background A systematic literature review of interspinous dynamic stabilization, including DIAM, Wallis, Coflex, and X-STOP, was conducted to assess its safety and efficacy. Methods The search was done in Korean and English, by using eight domestic databases which included KoreaMed and international databases, such as Ovid Medline, Embase, and the Cochrane Library. A total of 306 articles were identified, but the animal studies, preclinical studies, and studies that reported the same results were excluded. As a result, a total of 286 articles were excluded and the remaining 20 were included in the final assessment. Two assessors independently extracted data from these articles using predetermined selection criteria. Qualities of the articles included were assessed using Scottish Intercollegiate Guidelines Network (SIGN). Results The complication rate of interspinous dynamic stabilization has been reported to be 0% to 32.3% in 3- to 41-month follow-up studies. The complication rate of combined interspinous dynamic stabilization and decompression treatment (32.3%) was greater than that of decompression alone (6.5%), but no complication that significantly affected treatment results was found. Interspinous dynamic stabilization produced slightly better clinical outcomes than conservative treatments for spinal stenosis. Good outcomes were also obtained in single-group studies. No significant difference in treatment outcomes was found, and the studies compared interspinous dynamic stabilization with decompression or fusion alone. Conclusions No particular problem was found regarding the safety of the technique. Its clinical outcomes were similar to those of conventional techniques, and no additional clinical advantage could be attributed to interspinous dynamic stabilization. However, few studies have been conducted on the long-term efficacy of interspinous dynamic stabilization. Thus, the authors suggest further clinical studies be conducted to validate the theoretical advantages and clinical efficacy of this technique.
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Affiliation(s)
- Seon-Heui Lee
- Department of Nursing Science, Gachon University, Incheon, Korea
| | - Aram Seol
- The Health Insurance Review and Assessment Service, Seoul, Korea
| | - Tae-Young Cho
- Department of Neurosurgery, Korea University Hospital, Seoul, Korea
| | - Soo-Young Kim
- Department of Family Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Dong-Jun Kim
- Department of Orthopedic Surgery, Ewha Womans University Hospital, Seoul, Korea
| | - Hyung-Mook Lim
- Department of Orthopedic Surgery, Ewha Womans University Hospital, Seoul, Korea
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Erbulut DU, Zafarparandeh I, Hassan CR, Lazoglu I, Ozer AF. Determination of the biomechanical effect of an interspinous process device on implanted and adjacent lumbar spinal segments using a hybrid testing protocol: a finite-element study. J Neurosurg Spine 2015; 23:200-8. [DOI: 10.3171/2014.12.spine14419] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
The authors evaluated the biomechanical effects of an interspinous process (ISP) device on kinematics and load sharing at the implanted and adjacent segments.
METHODS
A 3D finite-element (FE) model of the lumbar spine (L1–5) was developed and validated through comparison with published in vitro study data. Specifically, validation was achieved by a flexible (load-control) approach in 3 main planes under a pure moment of 10 Nm and a compressive follower load of 400 N. The ISP device was inserted between the L-3 and L-4 processes. Intact and implanted cases were simulated using the hybrid protocol in all motion directions. The resultant motion, facet load, and intradiscal pressure after implantation were investigated at the index and adjacent levels. In addition, stress at the bone-implant interface was predicted.
RESULTS
The hybrid approach, shown to be appropriate for adjacent-level investigations, predicted that the ISP device would decrease the range of motion, facet load, and intradiscal pressure at the index level relative to the corresponding values for the intact spine in extension. Specifically, the intradiscal pressure induced after implantation at adjacent segments increased by 39.7% and by 6.6% at L2–3 and L4–5, respectively. Similarly, facet loads at adjacent segments after implantation increased up to 60% relative to the loads in the intact case. Further, the stress at the bone-implant interface increased significantly. The influence of the ISP device on load sharing parameters in motion directions other than extension was negligible.
CONCLUSIONS
Although ISP devices apply a distraction force on the processes and prevent further extension of the index segment, their implantation may cause changes in biomechanical parameters such as facet load, intradiscal pressure, and range of motion at adjacent levels in extension.
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Affiliation(s)
- Deniz U. Erbulut
- Departments of 1Mechanical Engineering and
- 2Neurosurgery, Koc University, Istanbul, Turkey
| | | | | | | | - Ali F. Ozer
- 2Neurosurgery, Koc University, Istanbul, Turkey
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Xu H, Liu X, Liu G, Zhao J, Fu Q, Xu B. Learning curve of full-endoscopic technique through interlaminar approach for L5/S1 disk herniations. Cell Biochem Biophys 2015; 70:1069-74. [PMID: 24839114 DOI: 10.1007/s12013-014-0024-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Although minimally invasive full-endoscopic (FE) spine surgery through the interlaminar approach has proved safe and effective for surgical treatment of lumbar disk herniation, the learning curve of the procedure has not been sufficiently established. The purpose of this study is to determine the learning curve for the FE surgery through interlaminar approach for treating the L5/S1 disk herniation. Thirty-six patients with lumbar disk herniation (L5/S1 segment) who underwent FE lumbar discectomy through the interlaminar approach between March 2011 and March 2012 were equally divided into Group A, B, and C by the study time of the surgeons. Clinical evaluation data included perioperative parameters (operative duration, intraoperative blood loss, and the amount of intraoperative bone and ligament excision), clinical curative effect index [visual analog scale (VAS) score for leg and back pain], complications, and the rate of conversion to open surgery. The operation duration, intraoperative bleeding, and the amount of bone and ligament excision were gradually and significantly reduced in the Groups A, B, and C (P < 0.01) and reflected in steep curves of proficiency suggesting that the rate of learning was fast. The VAS scores of leg and back pain were significantly improved (P < 0.01) and no symptomatic recurrence was noticed during the follow-up period (1-1.5 years). The outcomes the three groups were not significantly different. The clinical outcomes of the minimally invasive surgery for the treatment of L5/S1 segment disk herniation through the interlaminar approach were excellent suggesting of a satisfactory curative effect. The steep learning curves of perioperative parameters plotted against the number of surgeries conducted suggest that proficiency can be reached reasonably fast.
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Affiliation(s)
- Haidong Xu
- Department of Orthopedics of Jinling Hospital, Nanjing University School of Medicine, 305 Zhongshan East Road, Nanjing, Jiangsu, 210002, China
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Characterization of lumbar spinous process morphology: a cadaveric study of 2,955 human lumbar vertebrae. Spine J 2015; 15:1645-52. [PMID: 25777742 DOI: 10.1016/j.spinee.2015.03.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 02/07/2015] [Accepted: 03/07/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Despite the interest in lumbar spinous process (SP)-based surgical innovation, there are no large published studies that have characterized the morphometry of lumbar SPs. PURPOSE To provide accurate level-specific morphometric data with respect to human lumbar SPs using a human cadaveric lumbar spine model and to describe the morphometric variation of lumbar SPs with respect to gender, race, and age. STUDY DESIGN An anatomic observational study. METHODS This study used 2,955 cadaveric lumbar vertebrae from 591 adult spines at the Hamann-Todd Human Osteological Collection. Specimens were aged 20 to 79 years. Each vertebra was photographed in standardized positions and measured using ImageJ software. Direct measurements were made for the SP length, width, height, slope, and caudal morphology. Gender, race, and age were recorded and analyzed. RESULTS Spinous process length was 24.8±4.6 mm (L5) to 33.9±3.9 mm (L3). Effective length varied from 19.5±2.6 mm (L1) to 24.6±3.3 mm (L4). Height was shortest at L5 (18.2±2.7 mm). Caudal width was greater than the cranial width. Slope, caudal morphology, and radius measures showed large interspecimen variation. Slope at L5 was steeper than other levels (23.7°±10.5°, p<.0001). Most specimens demonstrated convex caudal morphology. L4 had the highest proportion of convexity (80.7%). L1 was the only level with predominantly concave morphology. Measurements for female SPs were smaller, but the slope was steeper. Anatomic and effective SP lengths were longer for specimens from white individuals. Specimens from black individuals had larger width and height, as well as steeper slope. Black specimens had more convex morphology at L4 and L5. With increasing age, the SP length, effective length, and width increased. Height increased with age only at L4 and L5. Slope and caudal radius of curvature decreased with age, and increasingly convex morphology was noted at most levels. CONCLUSIONS This large cadaveric study provides level-specific morphometric data regarding the osseous dimensions of lumbar SPs relevant to techniques and devices targeting the lumbar SPs or the interspinous space. Of particular importance is the recognition that L5 has relatively different morphology when compared with more cranial levels. Potentially important differences were noted comparing women with men, black with white, and aging populations.
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Bohm PE, Anderson KK, Friis EA, Arnold PM. Grade 1 spondylolisthesis and interspinous device placement: removal in six patients and analysis of current data. Surg Neurol Int 2015; 6:54. [PMID: 25883846 PMCID: PMC4395982 DOI: 10.4103/2152-7806.154461] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 11/12/2014] [Indexed: 01/18/2023] Open
Abstract
Background: In the treatment of patients with Grade 1 spondylolisthesis, the use of interspinous devices has been controversial for nearly a decade. Several authors have suggested that Grade 1 spondylolisthesis be considered a contraindication for interspinous device placement. Methods: We removed interspinous devices in six symptomatic Grade 1 spondylolisthesis patients and analyzed pertinent literature. Results: All six patients reported an improvement in symptoms following device removal and subsequent instrumented fusion. One patient who had not been able to walk due to pain regained the ability to walk. Several articles were identified related to spondylolisthesis and interspinous devices. Conclusions: Regarding patients receiving interspinous devices for symptomatic lumbar spinal stenosis, several high-quality studies have failed to demonstrate a statistical difference in outcomes between patients with or without Grade 1 spondylolisthesis. Nevertheless, surgeons should have a high degree of suspicion when considering use of interspinous devices in this patient population.
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Affiliation(s)
- Parker E Bohm
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, USA
| | - Karen K Anderson
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, USA
| | - Elizabeth A Friis
- Department of Mechanical Engineering, University of Kansas, Lawrence KS, USA
| | - Paul M Arnold
- Department of Neurosurgery, University of Kansas Medical Center, Kansas City, USA
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Hirsch C, Breque C, Ragot S, Pascal-Mousselard H, Richer JP, Scepi M, Khiami F. Biomechanical study of dynamic changes in L4-L5 foramen surface area in flexion and extension after implantation of four interspinous process devices. Orthop Traumatol Surg Res 2015; 101:215-9. [PMID: 25736197 DOI: 10.1016/j.otsr.2014.11.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 03/31/2014] [Accepted: 11/19/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Lumbar spinal stenosis is a major public health issue. Interspinous devices implanted using minimally invasive techniques may constitute an alternative to the reference standard of bony decompression with or without intervertebral fusion. However, their indications remain unclear, due to a paucity of clinical and biomechanical data. Our objective was to evaluate the effects of four interspinous process devices implanted at L4-L5 on the intervertebral foramen surface areas at the treated and adjacent levels, in flexion and in extension. MATERIALS AND METHOD Six fresh frozen human cadaver lumbar spines (L2-sacrum) were tested on a dedicated spinal loading frame, in flexion and extension, from 0 to 10 N·m, after preparation and marking of the L3-L4, L4-L5, and L5-S1 foramina. Stereoscopic 3D images were acquired at baseline then after implantation at L4-L5 of each of the four devices (Inspace(®), Synthes; X-Stop(®), Medtronic; Wallis(®), Zimmer; and Diam(®), Medtronic). The surface areas of the three foramina of interest were computed. RESULTS All four devices significantly opened the L4-L5 foramen in extension. The effects in flexion separated the devices into two categories. With the two devices characterized by fixation in the spinous processes (Wallis(®) and Diam(®)), the L4-L5 foramen opened only in extension; whereas with the other two devices (X-Stop(®) and Inspace(®)), the L4-L5 foramen opened not only in extension, but also in flexion and in the neutral position. None of the devices implanted at L4-L5 modified the size of the L3-L4 foramen. X-Stop(®) and Diam(®) closed the L5-S1 foramen in extension, whereas the other two devices had no effect at this level. CONCLUSION Our results demonstrate that interspinous process devices modify the surface area of the interspinous foramina in vitro. Clinical studies are needed to clarify patient selection criteria for interspinous process device implantation. LEVEL OF EVIDENCE Level IV. Investigating an orthopaedic device.
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Affiliation(s)
- C Hirsch
- Department of Orthopaedic Surgery, hôpital de la Pitié-Salpêtrière, AP-HP, UPMC University, 75013 Paris, France.
| | - C Breque
- Laboratoire d'anatomie, Université de Poitiers, 15 rue de l'Hôtel Dieu, TSA 71117, 86073 Poitiers Cedex 9, France
| | - S Ragot
- Clinical Investigation Centre, Poitiers University, Poitiers, France
| | - H Pascal-Mousselard
- Department of Orthopaedic Surgery, hôpital de la Pitié-Salpêtrière, AP-HP, UPMC University, 75013 Paris, France
| | - J-P Richer
- Anatomy Department, Poitiers University, Poitiers, France
| | - M Scepi
- Anatomy Department, Poitiers University, Poitiers, France
| | - F Khiami
- Department of Orthopaedic Surgery, hôpital de la Pitié-Salpêtrière, AP-HP, UPMC University, 75013 Paris, France
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Sclafani JA, Liang K, Ohnmeiss DD, Gordon C. Clinical outcomes of a polyaxial interspinous fusion system. Int J Spine Surg 2015; 8:14444-1035. [PMID: 25694912 PMCID: PMC4325480 DOI: 10.14444/1035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Early interspinous process fixation constructs utilize rigid fixation plates with immobile spikes which increase the difficulty of device implantation when anatomic variations are encountered. Second generation systems have been designed with polyaxial properties with the goal of accommodating natural osseous anatomic variations to achieve optimal implant placement and fixation integrity. The purpose of this study was to evaluate clinical outcomes in patients treated with this device to supplement the biomechanical data from previous studies. Methods A retrospective, non-randomized, single-center chart review at or beyond the one year postoperative time point was conducted to collect preoperative and perioperative data on patients treated with a polyaxial intraspinous fixation system. A postoperative numerical pain rating scale and modified MacNab classification score were obtained from each patient in the cohort via phone survey. Results A total of 53 patients were included in the study. Median hospital stay was 2 days (range 1-7 days). There were no reported perioperative blood transfusions or cases of radiographic fracture/migration of the device at the 6 week post-operative time point. There was a significant improvement in pain index score in the overall patient study group and a satisfactory (excellent or good) MacNab result was obtained in 48% of all patients. Patients with preoperative pain scores greater than 8/10 reported more pain improvement than patients with preoperative pain scores less than 5 (0 points, p = 0.96, n = 8). Patients with a BMI less than 30 had significantly better MacNab outcome classifications than patients with a BMI greater than 30. Conclusions The polyaxial interspinous fusion system produces significant clinical improvement when employed to treat patients with stenosis, herniated disc, or low grade spondylolisthesis. This device can be implanted with a low complication rate and short postoperative hospital admission time. Patients with high pre-operative pain score and BMI under 30 can be predictors of better clinical outcome and should be considered prior to implantation.
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Kulduk A, Altun NS, Senkoylu A. Biomechanical comparison of effects of the Dynesys and Coflex dynamic stabilization systems on range of motion and loading characteristics in the lumbar spine: a finite element study. Int J Med Robot 2015; 11:400-5. [DOI: 10.1002/rcs.1636] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 12/01/2014] [Accepted: 12/06/2014] [Indexed: 01/21/2023]
Affiliation(s)
- Ahmet Kulduk
- Department of Orthopedics and Traumatology; Gazi Mustafa Kemal State Hospital; Ankara Turkey
| | - Necdet S. Altun
- Department of Orthopedics and Traumatology; Gazi University Faculty of Medicine; Ankara Turkey
| | - Alpaslan Senkoylu
- Department of Orthopedics and Traumatology; Gazi University Faculty of Medicine; Ankara Turkey
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Skovrlj B, Gilligan J, Cutler HS, Qureshi SA. Minimally invasive procedures on the lumbar spine. World J Clin Cases 2015; 3:1-9. [PMID: 25610845 PMCID: PMC4295214 DOI: 10.12998/wjcc.v3.i1.1] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 10/29/2014] [Accepted: 10/31/2014] [Indexed: 02/05/2023] Open
Abstract
Degenerative disease of the lumbar spine is a common and increasingly prevalent condition that is often implicated as the primary reason for chronic low back pain and the leading cause of disability in the western world. Surgical management of lumbar degenerative disease has historically been approached by way of open surgical procedures aimed at decompressing and/or stabilizing the lumbar spine. Advances in technology and surgical instrumentation have led to minimally invasive surgical techniques being developed and increasingly used in the treatment of lumbar degenerative disease. Compared to the traditional open spine surgery, minimally invasive techniques require smaller incisions and decrease approach-related morbidity by avoiding muscle crush injury by self-retaining retractors, preventing the disruption of tendon attachment sites of important muscles at the spinous processes, using known anatomic neurovascular and muscle planes, and minimizing collateral soft-tissue injury by limiting the width of the surgical corridor. The theoretical benefits of minimally invasive surgery over traditional open surgery include reduced blood loss, decreased postoperative pain and narcotics use, shorter hospital length of stay, faster recover and quicker return to work and normal activity. This paper describes the different minimally invasive techniques that are currently available for the treatment of degenerative disease of the lumbar spine.
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Cai B, Ran B, Li Q, Li ZH, Li FN, Li M, Yan WJ. A morphometric study of the lumbar spinous process in the Chinese population. Braz J Med Biol Res 2015; 48:91-95. [PMID: 25493388 PMCID: PMC4288498 DOI: 10.1590/1414-431x20144164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 07/24/2014] [Indexed: 11/22/2022] Open
Abstract
Our goal was to analyze the anatomical parameters of the lumbar spine spinous process
for an interspinous stabilization device designed for the Chinese population and to
offer an anatomical basis for its clinical application. The posterior lumbar spines
(T12-S1) of 52 adult cadavers were used for measuring the
following: distance between two adjacent spinous processes (DB), distance across two
adjacent spinous processes (DA), thickness of the central spinous processes (TC),
thickness of the superior margin of the spinous processes (TS), thickness of the
inferior margin of the spinous processes (TI), and height of the spinous processes
(H). Variance and correlation analyses were conducted for these data, and the data
met the normal distribution and homogeneity of variance. DB decreased gradually from
L1-2 to L5-S1. DA increased from
T12-L1 to L2-3 and then decreased from
L2-3 to L4-5. The largest H in males was noted at
L3 (25.45±5.96 mm), whereas for females the largest H was noted at
L4 (18.71±4.50 mm). Usually, TS of the adjacent spinous process was
lower than TI. Based on the anatomical parameters of the lumbar spinous processes
obtained in this study, an “H”-shaped coronal plane (posterior view) was proposed as
an interspinous stabilization device for the Chinese population. This study reports
morphometric data of the lumbar spinous processes in the Chinese population, which
provides an anatomical basis for future clinical applications.
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Affiliation(s)
- B Cai
- Department of Orthopedics, Changhai Hospital Affiliated to the Second Military Medical University, Shanghai, China
| | - B Ran
- Department of Orthopedics, First Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Q Li
- Department of Orthopedics, Changhai Hospital Affiliated to the Second Military Medical University, Shanghai, China
| | - Z H Li
- Department of Orthopedics, First Affiliated Hospital of PLA General Hospital, Beijing, China
| | - F N Li
- Department of Orthopedics, Changhai Hospital Affiliated to the Second Military Medical University, Shanghai, China
| | - M Li
- Department of Orthopedics, Changhai Hospital Affiliated to the Second Military Medical University, Shanghai, China
| | - W J Yan
- Department of Orthopedic Oncology, Changzheng Hospital, The Second Military Medical University, Shanghai, China
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Yingsakmongkol W, Chaichankul C, Limthongkul W. Percutaneous interspinous distraction device for the treatment of lumbar spinal canal stenosis: clinical and radiographic results at 2-year follow-up. Int J Spine Surg 2014; 8:14444-1032. [PMID: 25694917 PMCID: PMC4325485 DOI: 10.14444/1032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Objective To evaluate the effectiveness of the In- space (Synthes, Umkirch, Germany) and the correlation between radiographic parameters and clinical outcome in patients with lumbar spinal canal stenosis (LSS). Methods Between June 2009 and May 2013, 56 patients with LSS underwent In-space by one senior surgeon. All of the patients were evaluated both clinically and radiographic measurements before the procedure and each visit at the postoperative follow-up. Preoperative and postoperative X-ray imaging was performed before the procedure and at follow-up to assess the correlation with the clinical outcome. Radiological measurements and clinical outcomes were recorded to establish a relationship between the radiographic parameters and clinical outcome of this procedure. All patients had at least 2 years of follow-up. Results The mean VAS score of back pain decreased significantly (p < 0.05). Conclusions Our data suggest that percutaneous interspinous devices are a good alternative to treat LSS. The device offers significant decrease in back pain, leg pain and ODI score with 2-year lasting relief from symptoms. The increased intervertebral foramenal space explains the improvement of leg pain, but the mechanism of back pain relief remains unclear. A very weak correlation between the radiographic changes and improvement of pain was found.
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Affiliation(s)
- Wicharn Yingsakmongkol
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Chaiyos Chaichankul
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Worawat Limthongkul
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Chopko B, Liu JC, Khan MK. Anatomic Surgical Management of Chronic Low Back Pain. Neuromodulation 2014; 17 Suppl 2:46-51. [PMID: 25395116 DOI: 10.1111/ner.12169] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 01/30/2014] [Indexed: 11/26/2022]
Affiliation(s)
- Bohdan Chopko
- Department of Neurosurgery; Stanford University; Stanford CA USA
| | - John C. Liu
- Cedars-Sinai Spine Center; Los Angeles CA USA
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Microdiscectomy with and without insertion of interspinous device for herniated disc at the L5–S1 level. J Clin Neurosci 2014; 21:1934-9. [DOI: 10.1016/j.jocn.2014.02.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Revised: 01/17/2014] [Accepted: 02/05/2014] [Indexed: 11/17/2022]
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Siewe J, Bredow J, Oppermann J, Koy T, Delank S, Knoell P, Eysel P, Sobottke R, Zarghooni K, Röllinghoff M. Evaluation of efficacy of a new hybrid fusion device: a randomized, two-centre controlled trial. BMC Musculoskelet Disord 2014; 15:294. [PMID: 25189113 PMCID: PMC4161882 DOI: 10.1186/1471-2474-15-294] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 09/02/2014] [Indexed: 11/13/2022] Open
Abstract
Background The 360° fusion of lumbar segments is a common and well-researched therapy to treat various diseases of the spine. But it changes the biomechanics of the spine and may cause adjacent segment disease (ASD). Among the many techniques developed to avoid this complication, one appears promising. It combines a rigid fusion with a flexible pedicle screw system (hybrid instrumentation, “topping off”). However, its clinical significance is still uncertain due to the lack of conclusive data. Methods/Design The study is a randomized, therapy-controlled, two-centre trial conducted in a clinical setting at two university hospitals. If they meet the criteria, outpatients presenting with degenerative disc disease, facet joint arthrosis or spondylolisthesis will be included in the study and randomized into two groups: a control group undergoing conventional fusion surgery (PLIF - posterior lumbar intervertebral fusion), and an intervention group undergoing fusion surgery using a new flexible pedicle screw system (PLIF + “topping off”), which was brought on the market in 2013. Follow-up examination will take place immediately after surgery, after 6 weeks and after 6, 12, 24 and 36 months. An ongoing assessment will be performed every year. Outcome measurements will include quality of life and pain assessments using validated questionnaires (ODI - Ostwestry Disability Index, SF-36™ - Short Form Health Survey 36, COMI - Core Outcome Measure Index). In addition, clinical and radiologic ASD, sagittal balance parameters and duration of work disability will be assessed. Inpatient and 6-month mortality, surgery-related data (e.g., intraoperative complications, blood loss, length of incision, surgical duration), postoperative complications (e.g. implant failure), adverse events, and serious adverse events will be monitored and documented throughout the study. Discussion New hybrid “topping off” systems might improve the outcome of lumbar spine fusion. But to date, there is a serious lack of and a great need of convincing data on safety or efficacy, including benefits and harms to the patients, of these systems. Health care providers are particularly interested in such data as these implants are much more expensive than conventional implants. In such a case, randomized clinical trials are the best way to evaluate benefits and risks. Trial registration NCT01852526
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Affiliation(s)
- Jan Siewe
- Department of Orthopaedic and Trauma Surgery, University of Cologne, Kerpener Strasse 62, 50924 Cologne, Germany.
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Sun X, Murgatroyd AA, Mullinix KP, Cunningham BW, Ma X, McAfee PC. Biomechanical and anatomical considerations in lumbar spinous process fixation--an in vitro human cadaveric model. Spine J 2014; 14:2208-15. [PMID: 24614251 DOI: 10.1016/j.spinee.2014.03.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 01/21/2014] [Accepted: 03/02/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Although multiple mechanisms of device attachment to the spinous processes exist, there is a paucity of data regarding lumbar spinous process morphology and peak failure loads. PURPOSE Using an in vitro human cadaveric spine model, the primary objective of the present study was to compare the peak load and mechanisms of lumbar spinous process failure with variation in spinous process hole location and pullout direction. A secondary objective was to provide an in-depth characterization of spinous process morphology. STUDY DESIGN Biomechanical and anatomical considerations in lumbar spinous process fixation using an in vitro human cadaveric model. METHODS A total of 12 intact lumbar spines were used in the current investigation. The vertebral segments (L1-L5) were randomly assigned to one of five treatment groups with variation in spinous process hole placement and pullout direction: (1) central hole placement with superior pullout (n=10), (2) central hole placement with inferior pullout (n=10), (3) inferior hole placement with inferior pullout (n=10), (4) superior hole placement with superior pullout (n=10), and (5) intact spinous process with superior pullout (n=14). A 4-mm diameter pin was placed through the hole followed by pullout testing using a material testing system. As well, the bone mineral density (BMD) (g/cm(3)) was measured for each segment. Data were quantified in terms of anatomical dimensions (mm), peak failure loads (newtons [N]), and fracture mechanisms, with linear regression analysis to identify relationships between anatomical and biomechanical data. RESULTS Based on anatomical comparisons, there were significant differences between the anteroposterior and cephalocaudal dimensions of the L5 spinous process versus L1-L4 (p<.05). Statistical analysis of peak load at failure of the four reconstruction treatments and intact condition demonstrated no significant differences between treatments (range, 350-500 N) (p>.05). However, a significant linear correlation was observed between peak failure load and anteroposterior and cephalocaudal dimensions (p<.05). Correlation between BMD and peak spinous processes failure load was approaching statistical significance (p=.08). 30 of 54 specimens failed via direct pullout (plow through), whereas 8 of 54 specimens demonstrated spinous process fracture. The remaining cases failed via plow through followed by fracture of the spinous process (16 of 54; 29%). CONCLUSIONS The present study demonstrated that variation in spinous process hole placement did not significantly influence failure load. However, there was a strong linear correlation between peak failure load and the anteroposterior and cephalocaudal anatomical dimensions. From a clinical standpoint, the findings of the present study indicate that attachment through the spinous process provides a viable alternative to attachment around the spinous processes. In addition, the anatomical dimensions of the lumbar spinous processes have a greater influence on biomechanical fixation than either hole location or BMD.
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Affiliation(s)
- Xiaolei Sun
- Department of Orthopaedic Surgery, Orthopaedic Spinal Research Institute, University of Maryland St. Joseph Medical Center, 7601 Osler Drive, Towson, MD 21204, USA; Department of Orthopaedic Surgery, Tianjin Hospital, 406 Jiefangnan Rd, Tianjin, TJ 300211, China
| | - Ashley A Murgatroyd
- Department of Orthopaedic Surgery, Orthopaedic Spinal Research Institute, University of Maryland St. Joseph Medical Center, 7601 Osler Drive, Towson, MD 21204, USA
| | - Kenneth P Mullinix
- Department of Orthopaedic Surgery, Orthopaedic Spinal Research Institute, University of Maryland St. Joseph Medical Center, 7601 Osler Drive, Towson, MD 21204, USA
| | - Bryan W Cunningham
- Department of Orthopaedic Surgery, Orthopaedic Spinal Research Institute, University of Maryland St. Joseph Medical Center, 7601 Osler Drive, Towson, MD 21204, USA.
| | - Xinlong Ma
- Department of Orthopaedic Surgery, Tianjin Hospital, 406 Jiefangnan Rd, Tianjin, TJ 300211, China
| | - Paul C McAfee
- Department of Orthopaedic Surgery, Orthopaedic Spinal Research Institute, University of Maryland St. Joseph Medical Center, 7601 Osler Drive, Towson, MD 21204, USA
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Marsh GDJ, Mahir S, Leyte A. A prospective randomised controlled trial to assess the efficacy of dynamic stabilisation of the lumbar spine with the Wallis ligament. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 23:2156-60. [DOI: 10.1007/s00586-014-3487-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 06/01/2014] [Accepted: 07/14/2014] [Indexed: 10/25/2022]
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Biomechanics of interspinous devices. BIOMED RESEARCH INTERNATIONAL 2014; 2014:839325. [PMID: 25114923 PMCID: PMC4119918 DOI: 10.1155/2014/839325] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 06/11/2014] [Accepted: 06/16/2014] [Indexed: 11/17/2022]
Abstract
A number of interspinous devices (ISD) have been introduced in the lumbar spine implant market. Unfortunately, the use of these devices often is not associated with real comprehension of their biomechanical role. The aim of this paper is to review the biomechanical studies about interspinous devices available in the literature to allow the reader a better comprehension of the effects of these devices on the treated segment and on the adjacent segments of the spine. For this reason, our analysis will be limited to the interspinous devices that have biomechanical studies published in the literature.
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A biomechanical cadaveric study of a modified U-shaped interspinous distraction device. ACTA ACUST UNITED AC 2014; 27:290-6. [PMID: 24979230 DOI: 10.1097/bsd.0000000000000049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
STUDY DESIGN An experimental study. OBJECTIVE To analyze the effects of a modified U-shape interspinous distraction device (IDD) on the stability of a destabilized lumbar spine model. SUMMARY OF BACKGROUND DATA The use of IDD for treatment of lumbar spine pathology remains a subject of debate. A modified design of an IDD consisted of a titanium (Ti) U-shape dynamic stabilizer and a Ti tensioning wire loop was biomechanically tested. MATERIALS AND METHODS Six sets of cadaveric lumbar vertebrae levels 1-5 (L1-L5) were subjected to loads in flexion, extension, and lateral bending in the 4 following sequences: intact specimen, unilateral facetectomy and discectomy at L3-L4, insertion of the modified U-shape IDD at L3-L4, and pedicle screw fixation at L3-L4. The range of motion (ROM) of L3-L4 following modified U-shape IDD insertion was compared with that of the intact specimen. The ROM of the adjacent vertebrae (L2-L3 and L4-L5) following modified U-shape IDD insertion was compared with that after pedicle screw fixation. Statistical analysis was performed using the Wilcoxon signed-rank test. RESULTS The modified U-shape IDD decreased the ROM of a destabilized L3-L4 in all testing load (P<0.05). The stability of L3-L4 following the modified U-shape IDD insertion was restored to that of the intact specimen (P>0.05). The ROM at adjacent vertebrae after the modified U-shape IDD placement was similar to the ROM obtained after pedicle screw fixation at L3-L4. CONCLUSIONS The modified version of a U-shape IDD is effective in stabilizing an unstable segment of the lumbar spine. The device does not create deleterious effects on the adjacent vertebrae.
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Controversies about interspinous process devices in the treatment of degenerative lumbar spine diseases: past, present, and future. BIOMED RESEARCH INTERNATIONAL 2014; 2014:975052. [PMID: 24822224 PMCID: PMC4005216 DOI: 10.1155/2014/975052] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 02/16/2014] [Accepted: 02/23/2014] [Indexed: 01/21/2023]
Abstract
A large number of interspinous process devices (IPD) have been recently introduced to the lumbar spine market as an alternative to conventional decompressive surgery in managing symptomatic lumbar spinal pathology, especially in the older population. Despite the fact that they are composed of a wide range of different materials including titanium, polyetheretherketone, and elastomeric compounds, the aim of these devices is to unload spine, restoring foraminal height, and stabilize the spine by distracting the spinous processes. Although the initial reports represented the IPD as a safe, effective, and minimally invasive surgical alternative for relief of neurological symptoms in patients with low back degenerative diseases, recent studies have demonstrated less impressive clinical results and higher rate of failure than initially reported. The purpose of this paper is to provide a comprehensive overview on interspinous implants, their mechanisms of action, safety, cost, and effectiveness in the treatment of lumbar stenosis and degenerative disc diseases.
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Külling FA, Florianz H, Reepschläger B, Gasser J, Jost B, Lajtai G. High Prevalence of Disc Degeneration and Spondylolysis in the Lumbar Spine of Professional Beach Volleyball Players. Orthop J Sports Med 2014; 2:2325967114528862. [PMID: 26535316 PMCID: PMC4555589 DOI: 10.1177/2325967114528862] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Beach volleyball is an intensive sport with high impact on the lumbar spine. Low back pain (LBP) is frequent among elite players. Increased prevalence of pathological changes on magnetic resonance imaging (MRI) in the lumbar spine of elite athletes has been reported. Hypothesis: There is an increased prevalence of disc degeneration and spondylolysis in the MRI of the lumbar spine of professional beach volleyball players. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Twenty-nine fully competitive professional male volleyball players (mean age, 28 years) completed outcomes questionnaires and underwent a complete clinical examination and an MRI of their lumbar spine. Results: Whereas 86% of players suffered from LBP during their career, the incidence of LBP in the last 4 weeks was 35%. Pain rated using a visual analog scale (VAS) averaged 3 points (range, 0-8). Twenty-three of 29 players (79%) had at least 1 degenerated disc of Pfirrmann grade ≥3. The most affected spinal levels were L4-5 in 14 (48%) and L5-S1 in 15 players (52%); both levels were involved in 5 players (17%). Six of 29 (21%) players showed a spondylolysis grade 4 according to the Hollenburg classification; there was evidence of spondylolisthesis in 2 players. There was no significant correlation between LBP and MRI abnormalities. Conclusion: In the lumbar spine MRI of professional beach volleyball players, the prevalence of disc degeneration is 79%. Spondylolysis (21%) is up to 3 times higher compared with the normal population. Abnormal MRI findings did not correlate with LBP, thus MRIs have to be interpreted with caution.
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Affiliation(s)
- Fabrice A Külling
- Department of Orthopaedics and Traumatology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Hannes Florianz
- Orthopaedic Department, Private Hospital Maria Hilf, Klagenfurt, Austria
| | - Bastian Reepschläger
- Department of Orthopaedics and Traumatology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Johann Gasser
- Radiology Department, Private Hospital Maria Hilf, Klagenfurt, Austria
| | - Bernhard Jost
- Department of Orthopaedics and Traumatology, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Georg Lajtai
- Orthopaedic Department, Private Hospital Maria Hilf, Klagenfurt, Austria
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Role of coflex as an adjunct to decompression for symptomatic lumbar spinal stenosis. Asian Spine J 2014; 8:161-9. [PMID: 24761198 PMCID: PMC3996340 DOI: 10.4184/asj.2014.8.2.161] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Revised: 02/17/2013] [Accepted: 02/17/2013] [Indexed: 11/08/2022] Open
Abstract
STUDY DESIGN Prospective cohort study. PURPOSE To assess whether additional implantation of Coflex following spinal decompression provided better clinical outcomes compared to decompression alone for symptomatic lumbar spinal stenosis (LSS) and to determine whether improvement in clinical outcomes correlated with changes in the radiological indices studied. OVERVIEW OF LITERATURE Literature on benefits of additional Coflex implantation compared to decompression alone for symptomatic LSS is limited. METHODS Patients with symptomatic LSS who met the study criteria were offered spinal decompression with Coflex implantation. Those patients who accepted Coflex implantation were placed in the Coflex group (n=22); while those opting for decompression alone, were placed in the comparison group (n=24). Clinical outcomes were assessed preoperatively, six-months, one-year and two-years postoperatively, using the Oswestry disability index, 100 mm visual analogue scale (VAS)-back pain and VAS-leg pain, and short form-36 (SF-36). Radiological indices (disc height, foraminal height and sagittal angle) were assessed preoperatively, six months, one year, and two years postoperatively. RESULTS Both groups showed statistically significant (p<0.001) improvement in all the clinical outcome indicators at all points in time as compared to the preoperative status. However, improvement in the Coflex group was significantly greater (p<0.001) than the comparison group. Changes in the radiological indices did not correlate significantly with the improvement in clinical outcome indicators. CONCLUSIONS Additional Coflex implantation after spinal decompression in symptomatic LSS offers better clinical outcomes than decompression alone in the short-term. Changes in radiological indices do not correlate with the improvements in clinical outcomes after surgery for symptomatic LSS.
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