#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Surgical Treatment of Lateral Lumbar Spinal Stenosis Using Percutaneous Interspinous Implant


Authors: M. Mrůzek;  T. Paleček;  R. Lipina
Authors‘ workplace: Neurochirurgická klinika LF OU a FN Ostrava
Published in: Cesk Slov Neurol N 2015; 78/111(2): 167-171
Category: Original Paper

Overview

Aim:
The authors present clinical and radiological results of a 3‑year follow‑up of patients after implantation of interspinous spacers for lateral stenosis.

Cohort and methodology:
We followed 42 patients with 62 implanted interspinous spacers for a period of three years. The indication for implantation was unilateral or bilateral lateral stenosis with degenerative disc disease. Patients were examined according to an algorithm involving: neurological examination, X‑ray –  plain and dynamic images, MRI, patients contraindicated for MRI underwent CT examination. Clinical findings were assessed using a VAS score, ODI and Odom criteria. X‑rays were performed and the range of motion, distraction in ventral and dorsal areas of the intervertebral disc and foramen intervertebrale and the position of the implant were evaluated. Six months and two years post‑surgery, patients underwent postoperative MRI examination and intervertebral foramen distraction in anteroposterior and craniocaudal diameter, and the assessment was compared with preoperative findings.

Results:
Implantation of interspinous spacers in the lumbar spine in a 3-year follow‑up period was followed by the mean improvement of 2.7 points on VAS score, and of 24.5% on ODI. Statistically significant difference in the distraction of the intervertebral foramen in the dorsal part of the intervertebral disc was proven by pre‑ and post‑operative MRI.

Conclusion:
Implantation of a spacer led to improved ODI and VAS parameters, distraction in the region of the intervertebral foramen, especially in the AP diameter, and in the dorsal part of an intervertebral disc.

Key words:
lumbar stenosis – surgical treatment – decompression – distraction

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manu­script met the ICMJE “uniform requirements” for biomedical papers.


Sources

1. Paleček T, Mrůzek M, Fedáková H, Holáňová R. Lumbální laterální spinální stenóza degenerativního původu. Rehabilitácia 2009; 46(4): 237– 243.

2. Němec F, Ryba L, Repko M, Chaloupka R. Kvalita života u pa­cientů po operaci degenerativní stenózy bederní páteře po 3 letech sledování. Acta Chir Orthop Traum Cech 2010; 77: 484– 488.

3. Katz JN, Lipson SJ, Lew RA, Globler LI, Einstein JN, Brick GWet al. Lumbar laminectomy alone with instrumented or noninstrumented arthrodesis in degenerative lumbar spinal stenosis. Patient selection, cost and survival outcomes. Spine 1997; 22(10): 1123– 1131.

4. Murphy DR, Hurwitz EL, Gregory AA, Clary R. A non‑surgical approach to the management of lumbar spinal stenosis: a prospective observational cohort study. BMC Musculoskelet Disord 2006; 16: 1471– 1474.

5. Aota Y, Niwa T, Yoshikawa K, Fujiwara A, Asada T, Saito T.Magnetic resonance imaging and magnetic resonance myelography in the presurgical dia­gnosis of lumbar foraminal stenosis. Spine 2007; 32(8): 896– 903.

6. Rudinský B et al. Spinálna chirurgia II. In: Paleček T (ed). Lumbální stenóza páteřního kanálu. 1. vyd. Bratislava: SAP 2012: 29– 33.

7. Lauryssen C. Technical advances in minimally invasive surgery: direct decompression for lumbar spinal stenosis. Spine 2010; 35 (Suppl 26): S287– S293. doi: 10.1097/ BRS.0b013e3182023268.

8. Collignon F, Fransen P. Treatment of symp­tomatic degenerative lumbar spinal stenosis by a percutaneous stand- alone implant. Neurochirurgie 2010; 56(1): 3– 7. doi: 10.1016/ j.neuchi.2009.12.003.

9. Náhlovský et al. Neurochirurgie. In: Málek V (ed). Spinální bederní stenóza. 1. vyd. Praha: Galén 2006: 368– 372.

10. Swanson KE, Lindsay DP, Hsu KY, Zucherman JF, Yerby SA. The effects of an interspinous implant on intervertebral disc pressures. Spine 2003; 28(1): 26– 32.

11. Fairbank JCT, Pynsent PB. The Oswestry disability index. Spine 2000; 25(22): 2940– 2952.

12. Christie SD, Song JK, Fessler RG. Dynamic interspinous process technology. Spine 2005; 30 (Suppl 16): S73– S78.

13. Hrabálek L, Wanek T, Adamus M. Léčba juxtafacetárních cyst bederní páteře perkutánní dynamickou interspinózní stabilizací: prospektivní studie. Acta Chir Orthop Traumatol Cech 2012; 79(2): 144– 149.

14. Hobart J, Gilkes C, Adams W, German T. Interspinous spacers for lumbar foraminal stenosis: formal trials are justified. Eur Spine J 2013; 22 (Suppl 1): S47– S53. doi: 10.1007/ s00586‑ 012‑ 2650‑ z.

15. Wilke HJ, Drumm J, Haussler K, Mack C, Steudel I, Kettler A. Biomechanical effect of different lumbar interspinous implants on flexibility and intradiscal pressure. Eur Spine J 2008; 17(8): 1049– 1056. doi: 10.1007/ s00586‑ 008‑ 0657‑ 2.

16. Richards JC, Majumdar S, Lindsey DP, Beaupré GS, Yerby SA. The treatment mechanism of an interspinous proces implant for lumbar neurogenic intermittent cladication. Spine 2005; 30(7): 744– 749.

17. Richter A, Schutz Ch, Hauck M, Halm H. Does an interspinous device (Coflex) improve the outcome of decompressive surgery in lumbar spinal stenosis? One year follow up of a prospective case control study of 60 patients. Eur Spine J 2010; 19(2): 283– 289. doi: 10.1007/ s00586‑ 009‑ 1229‑ 9.

18. Polly DW jr, Santos ERG, Mehbod AA. Surgical treatment for the painful motion segment. Spine 2005; 30 (Suppl 16): 44– 51.

19. Rudinský et al. Spinálna chirurgia II. In: Hrabálek L (ed). Perkutánní interspinózní dynamická stabilizace bederní páteře (In Space). 1. vyd. Bratislava: SAP 2012: 127– 130.

20. Lazaro BC, Brasiliense LBC, Sawa AGU, Reyes PM, Theodore N, Sonntag VK et al. Biomechanics of a novel minimally invasive lumbar interspinous spacer: effects of kinematice, facet loads, and foraminal height. Neurosurgery 2010; 66 (Suppl 3): 126– 132. doi: 10.1227/ 01.NEU.0000348561.59062.A2.

21. Mayer HM, Zentz F, Siepe C, Korge A. Percutaneous interspinous distraction for the treatment of dynamic lumbar spinal stenosis and low back pain. Oper Orthop Traumatol 2010; 22(5– 6): 495– 511. doi: 10.1007/  s00064‑ 010‑ 1004‑ 4.

22. Mayer HM, Korge A. Microsurgical decompression of degenerative lumbar spinal stenosis. Eur Spine J 2009; 18(12): 1989– 1990. doi: 10.1007/ s00586‑ 009‑ 1221‑ 4.

23. Richards JC, Majumdar S,Lindsey DP, Beaupré GS,Yerby SA. The treatment mechanism of an interspinous proces implant for lumbar neurogenic intermittent claudication. Spine 2005; 30(7): 744– 749.

24. Hrabálek L, Novotný J, Koluchová J, Vaverka M, Kalita O,Langová K. Změny parametrů páteře po implantaci bederní interspinósní rozpěrky DIAM. Cesk Slov Neurol N 2009; 72/ 105(4): 337– 342.

25. Siddiqui M,Karadimas E,Nicol M, Smith FW, Wardlaw D. Influence of X stop on neural foramina and spinal canal area in spinal stenosis. Spine 2006; 31(25): 2958– 2962.

26. Zucherman JF, Hsu KY, Hartjen CA, Mehalic TF, Implicite DA, Martin MJ et al. A prospective randomized multi‑center study for the treatment of lumar spinal stenosis with the X STOP interspinous implant: 1‑year results. Eur Spine J 2004; 13(1): 22– 32.

27. Kuchta J, Sobottke R, Eysel P, Simons P. Two‑year results of interspinous spacer implantation in 175 patients with neurologic intermittent claudication due to lumbar stenosis. Eur Spine J 2009; 18(6): 823– 829. doi: 10.1007/ s00586‑ 009‑ 0967‑ z.

28. Leahy JC, Mathias KJ, Heaton A, Shepherd DE, Hukins DW,Deans WF et al. Design of spinous process hooks for flexible fixation of the lumbar spine. Proc Inst Mech Eng 2000; 214(5): 479– 487.

29. Talwar V, Lindsey DP, Fredrick A, Hsu KY, Zucherman JF,Scott AY. Insertion loads of the X STOP interspinous process distraction system designed to treat neurogenic intermittent claudication. Eur Spine J 2006; 15(6): 908– 912.

30. Kim KA, McDonald M, Pik JH, Khoueir P, Wang MY. Dynamic interspinous spacer technology for posterior stabilisation: case control study on the safety, sagittal angulation, and pain outcome at 1‑year follow‑up evaluation. Neurosurg Focus 2007; 22(1): E7.

31. Dickey JP, Gillespie KA. Biomechanical role of lumbar spine ligaments in flexion and extension: determination using a parallel linkage robot and a porcine model. Spine 2004; 29(11): 1208– 1216.

32. Barbagallo GM, Olindo G, Corbino L, Albanese V. Analysis of complication in patients treated with the X STOP interspinous proces decompresion system: proposal for a novel anatomic scoring system for patient selection and review of the literature. Neurosurgery 2009; 65(1): 111– 120. doi: 10.1227/ 01.NEU.0000346254.07116.31.

33. Chung KJ,Hwang YS, Koh SH. Stress fracture of bilateral posterior facet after insertion of interspinous implant. Spine 2009; 34(10): 380– 384. doi: 10.1097/ BRS.0b013e31819fd3a0.

Labels
Paediatric neurology Neurosurgery Neurology

Article was published in

Czech and Slovak Neurology and Neurosurgery

Issue 2

2015 Issue 2

Most read in this issue
Topics Journals
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#