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Katiyar P, Malka M, Reyes JL, Lombardi JM, Lenke LG, Sardar ZM. Innovative technologies in thoracolumbar and lumbar spine surgery failing to reach standard of care: state-of-art review. Spine Deform 2024:10.1007/s43390-024-00898-9. [PMID: 38795313 DOI: 10.1007/s43390-024-00898-9] [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: 11/01/2023] [Accepted: 05/15/2024] [Indexed: 05/27/2024]
Abstract
PURPOSE To evaluate previously popular technologies in the field of spine surgery, and to better understand their advantages and limitations to the current standards of care. Spine surgery is an ever-evolving field that serves to resolve various spinal pathologies in patients of all ages. While there are established treatments for various conditions, such as lumbar spinal stenosis, idiopathic scoliosis, and degenerative lumbar disease, there is always further research and development in these areas to produce innovative technologies that can lead to better outcomes. As this process progresses, we must remind ourselves of previously tried and tested inventions and their outcomes that have fallen short of becoming a standard to ensure we are able to learn lessons from the past. METHODS A thorough literature review was conducted with the aim of compiling literature of previously utilized technologies in spine surgery. Biomedical databases were utilized to gather relevant articles including PubMed, MEDLINE, and EMBASE. Emphasis was placed on gathering articles with technologies or therapeutics aimed at treating common spinal pathologies including lumbar spinal stenosis (LSS), adolescent idiopathic scoliosis (AIS), and other degenerative lumbar spine diseases. The keywords used were: "failed technologies", "historical technologies", "spine surgery", "spinal stenosis", "adolescent idiopathic scoliosis", and "degenerative lumbar spine disease". A total of 47 articles were gathered after initial review. RESULTS Different technologies pertaining to spine surgery were identified and critically evaluated. Some of these technologies included X-STOP, Vertiflex, Vertebral Body Stapling, and Dynesys. These technologies were evaluated for their strengths and limitations across their spinal pathology applications. While each type of technology had their benefits, the data tended to be mixed with various limitations across studies. CONCLUSION These technologies have been trialed in the field of spine surgery across various spinal pathologies, but still prove of limited efficacy and shortcomings to the current standards of care.
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Affiliation(s)
- Prerana Katiyar
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, Och Spine Hospital, New York-Presbyterian/Allen, New York, USA
| | - Matan Malka
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, Och Spine Hospital, New York-Presbyterian/Allen, New York, USA
| | - Justin L Reyes
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, Och Spine Hospital, New York-Presbyterian/Allen, New York, USA.
| | - Joseph M Lombardi
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, Och Spine Hospital, New York-Presbyterian/Allen, New York, USA
| | - Lawrence G Lenke
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, Och Spine Hospital, New York-Presbyterian/Allen, New York, USA
| | - Zeeshan M Sardar
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, Och Spine Hospital, New York-Presbyterian/Allen, New York, USA
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Han B, Chen Y, Liang W, Yang Y, Ding Z, Yin P, Hai Y. Is the interspinous process device safe and effective in elderly patients with lumbar degeneration? A systematic review and meta-analysis of randomized controlled trials. 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 2024; 33:881-891. [PMID: 38342843 DOI: 10.1007/s00586-023-08119-z] [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: 05/23/2023] [Revised: 11/05/2023] [Accepted: 12/22/2023] [Indexed: 02/13/2024]
Abstract
BACKGROUND CONTEXT Lumbar spinal stenosis is one of the most common diseases affecting the elderly that is characterized by the narrowing of the spinal canal and peripheral neural pathways which may cause back pain and neurogenic intermittent claudication in affected patients. Recently, as an alternative treatment between conservative therapy and decompression surgery, interspinous process device (IPD) such as X-stop, Coflex, DIAM, Aperius, Wallis, etc., has gained enough popularity. PURPOSE The purpose of this study was to evaluate the efficacy and safety of IPD in the treatment of degenerative lumbar spinal stenosis compared with decompression surgery. STUDY DESIGN This study was a systematic review and meta-analysis of randomized controlled trials. PATIENT SAMPLE 555 patients' samples were collected for this study. OUTCOME MEASURES The Visual Analogue Scale and the Oswestry Disability Index were analyzed, as well as the Zurich Claudication Questionnaire For efficacy evaluation. Complication and reoperation rate was utilized for the assessment of safety. METHODS A comprehensive literature search was performed through Pubmed, EMBASE, Web of Science, and Cochrane Library until October 2023. Among the studies meeting the eligible criteria, any study in which IPD was utilized in the treatment of degenerative lumbar spinal stenosis was included in the current review. For efficacy evaluation, the Visual Analogue Scale and the Oswestry Disability Index were analyzed, as well as the Zurich Claudication Questionnaire. Complication and reoperation rates were utilized for the assessment of safety. RESULTS Five randomized controlled trials with 555 patients were included. There were no significant differences in VAS leg pain (SMD - 0.08, 95% CI - 0.32 to 0.15) and back pain (SMD 0.09, 95%CI-0.27 to 0.45), ODI scores (MD 1.08, 95% CI - 11.23 to 13.39) and ZCQ physical function (MD-0.09, 95% CI-0.22 to 0.05) for IPD compared with decompression surgery. In terms of ZCQ symptom severity (MD - 0.22, 95% CI - 0.27 to - 016), decompression surgery showed superior to the IPD. As for complications (RR 1.08, 95% CI 0.36 to 3.27), the IPD had no advantages compared to decompression surgery, whereas inferior to it in reoperation rate (RR 2.58, 95% CI 1.67 to 3.96). CONCLUSIONS This systematic review and meta-analysis indicated no superiority in the clinical outcome for IPD compared with decompression surgery. However, more clinical studies are warranted to determine the efficacy and safety of IPD.
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Affiliation(s)
- Bo Han
- Department of Orthopedic, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gong Ti Nan Road, Beijing, Chaoyang District, 100020, China
| | - Yuxiang Chen
- Plastic Surgery Hospital, Peking Union Medical. College, Chinese Academy of Medical Sciences, 33 Badachu Road, Beijing, Shijingshan District, China
| | - Weishi Liang
- Department of Orthopedic, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gong Ti Nan Road, Beijing, Chaoyang District, 100020, China
| | - Yihan Yang
- Department of Orthopedic, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gong Ti Nan Road, Beijing, Chaoyang District, 100020, China
| | - Zihao Ding
- Department of Orthopedic, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gong Ti Nan Road, Beijing, Chaoyang District, 100020, China
| | - Peng Yin
- Department of Orthopedic, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gong Ti Nan Road, Beijing, Chaoyang District, 100020, China.
| | - Yong Hai
- Department of Orthopedic, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gong Ti Nan Road, Beijing, Chaoyang District, 100020, China.
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Xin JH, Che JJ, Wang Z, Chen YM, Leng B, Wang DL. Effectiveness and safety of interspinous spacer versus decompressive surgery for lumbar spinal stenosis: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2023; 102:e36048. [PMID: 37986330 PMCID: PMC10659713 DOI: 10.1097/md.0000000000036048] [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: 08/02/2023] [Revised: 09/19/2023] [Accepted: 10/19/2023] [Indexed: 11/22/2023] Open
Abstract
STUDY DESIGN A meta-analysis of randomized controlled trials. OBJECTIVE Our meta-analysis was conducted to investigate whether interspinous spacer (IS) results in better performance for patients with lumbar spinal stenosis (LSS) when compared with decompressive surgery (DS). BACKGROUND DATA DS and IS are common surgeries for the treatment of LSS. However, controversy remains as to whether the IS is superior to DS. METHODS We comprehensively searched PubMed, EMBASE, and Cochrane Central Register of Controlled Trials for prospective randomized controlled trials that compared IS versus DS for LSS. The retrieved results were last updated on July 30, 2023. RESULTS Eight studies involving 852 individuals were included in the meta-analysis. The pooled data indicated that IS was superior to DS considering shorter operation time (P = .003), lower dural violation rate (P = .002), better Zurich Claudication Questionnaire Physical function score (P = .03), and smaller foraminal height decrease (P = .004), but inferior to DS considering the higher rate of reoperation (P < .0001). There was no significant difference between the 2 groups regarding hospital stay (P = .26), blood loss (P = .23), spinous process fracture (P = .09), disc height decrease (P = .87), VAS leg pain score (P = .43), VAS back pain score (P = .26), Oswestry Disability Index score (P = .08), and Zurich Claudication Questionnaire symptom severity (P = .50). CONCLUSIONS In summary, we considered that IS had similar effects with DS in hospital stay, blood loss, spinous process fracture, disc height decrease, VAS score, Oswestry Disability Index score, and Zurich Claudication Questionnaire Symptom severity, and was better in some indices such as operation time, dural violation, Zurich Claudication Questionnaire Physical function, and foraminal height decrease than DS. However, due to the higher rate of reoperation in the IS group, we considered that both IS and DS were acceptable strategies for treating LSS. As a novel technique, further well-designed studies with longer-term follow-up are needed to evaluate the effectiveness and safety of IS.
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Affiliation(s)
- Jian-Hai Xin
- Department One of Orthopedics, Affiliated Hospital of Beihua University, Jilin, China
| | - Jia-Ju Che
- Department One of Orthopedics, Affiliated Hospital of Beihua University, Jilin, China
| | - Zhe Wang
- Department One of Orthopedics, Affiliated Hospital of Beihua University, Jilin, China
| | - Yu-Ming Chen
- Department One of Orthopedics, Affiliated Hospital of Beihua University, Jilin, China
| | - Bing Leng
- Department One of Orthopedics, Affiliated Hospital of Beihua University, Jilin, China
| | - Da-Lin Wang
- Department One of Orthopedics, Affiliated Hospital of Beihua University, Jilin, China
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Druszcz A, Miś M, Paprocka-Borowicz M, Rosińczuk J, Czapiga B. Comparative Analysis of Early and Long-Term Outcomes of Patients with Degenerative Lumbar Spine Disease Using the DIAM Stabilizer and Standard Rehabilitation Program: A Preliminary Prospective Randomized Controlled Trial with 1-Year Follow-Up. Healthcare (Basel) 2023; 11:2956. [PMID: 37998448 PMCID: PMC10671364 DOI: 10.3390/healthcare11222956] [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: 10/01/2023] [Revised: 11/09/2023] [Accepted: 11/11/2023] [Indexed: 11/25/2023] Open
Abstract
Low back pain (LBP) is a leading cause of disability and work absenteeism. The cause of LBP may be degeneration of the intervertebral disc. LBP is characterized by considerable variability and tends to develop into chronic pain. Treatment of LBP includes conservative and rehabilitative treatments, surgery, and so-called minimally invasive treatment. One of the most commonly performed procedures is interspinous stabilization using a dynamic interspinous DIAM (device for intervertebral assisted motion) stabilizer. There is still no clear, strong evidence for the effectiveness and superiority of surgical treatment over conservative treatment. This study aimed to compare the early and long-term outcomes of patients with LBP using the DIAM interspinous stabilizer in relation to patients treated conservatively. A group of 86 patients was prospectively randomized into two comparison groups: A (n = 43), treated with the DIAM dynamic stabilizer for degenerative lumbar spine disease (mean age = 43.4 years ± SD = 10.8 years), and B (n = 43), treated conservatively. Pain severity was assessed using the visual analog scale (VAS), whereas disability was assessed using the Oswestry disability index (ODI). The difference in preoperative and postoperative ODI scores ≥ 15 points was used as a criterion for treatment effectiveness, and the difference in VAS scores ≥ 1 point was used as a criterion for pain reduction. In patients under general anesthesia, the procedure only included implantation of the DIAM system. Patients in the control group underwent conservative treatment, which included rehabilitation, a bed regimen, analgesic drug treatment and periarticular spinal injections of anti-inflammatory drugs. It was found that all patients (n = 43) continued to experience LBP after DIAM implantation (mean VAS score of 4.2). Of the 36 patients who experienced LBP with sciatica before the procedure, 80.5% (n = 29) experienced a reduction in pain. As for the level of fitness, the average ODI score was 19.3 ± 10.3 points. As for the difference in ODI scores in the pre-treatment results vs. after treatment, the average score was 9.1 ± 10.6. None of the patients required reoperation at 12 months after surgery. There were no statistically significant differences between the two groups in either early (p = 0.45) or long-term outcomes (p = 0.37). In conclusion, neurosurgical treatment with the DIAM interspinous stabilizer was as effective as conservative treatment and rehabilitation during the one-year follow-up period.
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Affiliation(s)
- Adam Druszcz
- Department of Neurosurgery, Provincial Specialist Hospital in Legnica, 59-220 Legnica, Poland;
| | - Maciej Miś
- Department of Neurosurgery, Specialist Hospital in Walbrzych, 58-309 Walbrzych, Poland;
| | | | - Joanna Rosińczuk
- Department of Nursing and Obstetrics, Wroclaw Medical University, 51-618 Wroclaw, Poland
| | - Bogdan Czapiga
- Department of Neurosurgery, 4th Military Clinical Hospital in Wroclaw, 50-981 Wroclaw, Poland;
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Sarikonda A, Leibold A, Sivaganesan A. When Does Intervention End and Surgery Begin? The Role of Interventional Pain Management in the Treatment of Spine Pathology. Curr Pain Headache Rep 2023; 27:707-717. [PMID: 37713091 DOI: 10.1007/s11916-023-01165-8] [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] [Accepted: 08/09/2023] [Indexed: 09/16/2023]
Abstract
PURPOSE OF REVIEW Recent advances in the field of interventional pain management (IPM) involve minimally invasive procedures such as percutaneous lumbar decompression, interspinous spacer placement, interspinous-interlaminar fusion and sacroiliac joint fusion. These developments have received pushback from surgical professional societies, who state spinal instrumentation and arthrodesis should only be performed by spine surgeons. The purpose of this review is to evaluate the validity of this claim. A literature search was conducted on Google Scholar and PubMed databases. Articles were included which examined IPM in the following contexts: credentialing and procedural privileging guidelines, fellowship training and education, and procedural outcomes compared to those of surgical specialties. Our primary research question is: "Should interventionalists be performing decompression and fusion procedures?". FINDINGS Advanced percutaneous spine procedures are not universally incorporated into pain fellowship curriculums. Trainees attempt to compensate for these deficiencies through industry-led training, which has been criticized for lacking central regulation. There is also a paucity of studies comparing procedural outcomes between surgeons and interventionalists for complex spine procedures, including decompression and fusion. Pain fellowship curriculums have not kept pace with some of procedural advancements within the field. Interventionalists are also not trained to manage potential complications of spinal instrumentation and arthrodesis, which has been recognized as an essential requirement for procedural privileging. Decompression and fusion may therefore be outside the scope of an interventionalist's practice.
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Affiliation(s)
- Advith Sarikonda
- Department of Neurological Surgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University, 901 Walnut Street, Philadelphia, PA, 19107, USA
| | - Adam Leibold
- Department of Neurological Surgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University, 901 Walnut Street, Philadelphia, PA, 19107, USA
| | - Ahilan Sivaganesan
- Department of Neurological Surgery, Jefferson Hospital for Neuroscience, Thomas Jefferson University, 901 Walnut Street, Philadelphia, PA, 19107, USA.
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Staats PS, Hagedorn JM, Reece DE, Strand NH, Poree L. Percutaneous image-guided lumbar decompression and interspinous spacers for the treatment of lumbar spinal stenosis: A 2-year Medicare Claims Benchmark Study. Pain Pract 2023; 23:776-784. [PMID: 37254613 DOI: 10.1111/papr.13256] [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: 11/12/2022] [Revised: 03/07/2023] [Accepted: 05/12/2023] [Indexed: 06/01/2023]
Abstract
OBJECTIVE This prospective longitudinal study compares outcomes between Medicare beneficiaries receiving percutaneous image-guided lumbar decompression (PILD) using the mild® procedure and a control group of patients receiving interspinous spacers for the treatment of lumbar spinal stenosis (LSS) with neurogenic claudication (NC). METHODS Patients diagnosed with LSS with NC and treated with either the mild procedure or a spacer were identified in the Medicare claims database. The incidence of harms, the rate of subsequent interventions, and the overall combined rate of harms and subsequent interventions during 2-year follow-up after the index procedure were compared between the two groups and assessed for statistical significance with p = 0.05. RESULTS The study included 2229 patients in the mild group and 3401 patients who were implanted with interspinous spacers. The rate of harms for those treated with the mild procedure was less than half that of patients implanted with a spacer (5.6% vs. 12.1%, respectively; p < 0.0001) during 2-year follow-up. The rate of subsequent interventions was not significantly different between the two groups (24.9% and 26.1% for the mild and spacer groups, respectively; p = 0.7679). The total rate of harms and subsequent interventions for mild was found to be noninferior to spacers (p < 0.0001). CONCLUSIONS This comprehensive study of real-world Medicare claims data demonstrated a significantly lower rate of harms for the mild procedure compared to interspinous spacers for patients diagnosed with LSS with NC, and a similar rate of subsequent interventions during 2-year follow-up.
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Affiliation(s)
- Peter S Staats
- National Spine and Pain Centers, Atlantic Beach, Florida, USA
| | | | - David E Reece
- Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | | | - Lawrence Poree
- Department of Anesthesia and Perioperative Care, UCSF Pain Management Center, University of California at San Francisco, San Francisco, California, USA
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Whang PG, Tran O, Rosner HL. Longitudinal Comparative Analysis of Complications and Subsequent Interventions Following Stand-Alone Interspinous Spacers, Open Decompression, or Fusion for Lumbar Stenosis. Adv Ther 2023; 40:3512-3524. [PMID: 37289411 PMCID: PMC10329952 DOI: 10.1007/s12325-023-02562-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 05/17/2023] [Indexed: 06/09/2023]
Abstract
INTRODUCTION For individuals with lumbar spinal stenosis (LSS), minimally invasive procedures such as an interspinous spacer device without decompression or fusion (ISD) or open surgery (i.e., open decompression or fusion) may relieve symptoms and improve functions when patients fail to respond to conservative therapies. This research compares longitudinal postoperative outcomes and rates of subsequent interventions between LSS patients treated with ISD and those with open decompression or fusion as their first surgical intervention. METHODS This retrospective, comparative claims analysis identified patients age ≥ 50 years with LSS diagnosis and with a qualifying procedure during 2017-2021 in the Medicare database which includes healthcare encounters in inpatient and outpatient settings. Patients were followed from the qualifying procedure until end of data availability. The outcomes assessed during the follow-up included subsequent surgical interventions, including subsequent fusion and lumbar spine surgeries, long-term complications, and short-term life-threatening events. Additionally, the costs to Medicare during a 3-year follow-up were calculated. Cox proportional hazards, logistic regression, and generalized linear models were used to compare outcomes and costs, adjusted for baseline characteristics. RESULTS A total of 400,685 patients who received a qualifying procedure were identified (mean age 71.5 years, 50.7% male). Compared to ISD patients, patients receiving open surgery (i.e., decompression and/or fusion) were more likely to have a subsequent fusion [hazard ratio (HR), 95% confidence intervals (CI): 1.49 (1.17, 1.89)-2.54 (2.00, 3.23)] or other lumbar spine surgery [HR (CI): 3.05 (2.18, 4.27)-5.72 (4.08, 8.02)]. Short-term life-threatening events [odds ratio (CI): 2.42 (2.03, 2.88)-6.36 (5.33, 7.57)] and long-term complications [HR (CI): 1:31 (1.13, 1.52)-2.38 (2.05, 2.75)] were more likely among the open surgery cohorts. Adjusted mean index costs were lowest for decompression alone (US$7001) and highest for fusion alone ($33,868). ISD patients had significantly lower 1-year complication-related costs than all surgery cohorts and lower 3-year all-cause costs than fusion cohorts. CONCLUSIONS ISD resulted in lower risks of short- and long-term complications and lower long-term costs than open decompression and fusion surgeries as a first surgical intervention for LSS.
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Affiliation(s)
- Peter G Whang
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT, USA
| | - Oth Tran
- Boston Scientific Corporation, Valencia, CA, USA.
| | - Howard L Rosner
- Pain Medicine, Anesthesiology, Cedars Sinai, Los Angeles, CA, USA
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Malik KN, Giberson C, Ballard M, Camp N, Chan J. Pain Management Interventions in Lumbar Spinal Stenosis: A Literature Review. Cureus 2023; 15:e44116. [PMID: 37753034 PMCID: PMC10518428 DOI: 10.7759/cureus.44116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2023] [Indexed: 09/28/2023] Open
Abstract
Lumbar spinal stenosis (LSS) occurs due to the narrowing of the space within the vertebral canal and or intervertebral foramina. This results in the compression of the spinal cord and possibly the roots of the spinal nerves. Lower back pain and neurogenic claudication (NC) are major symptoms of spinal stenosis. This is a literature review that summarizes the important findings pertaining to pain management of spinal stenosis. Twenty-four original articles were assessed. Pain can be treated through non-invasive or surgical methods. Conservative techniques include physical exercises, epidural corticosteroid injection, local anesthetic injection therapy, and oral analgesics. Surgical intervention deals with the decompression of the affected spinal region, with or without vertebral fusion surgery. Other novel surgical techniques include implantation of specific equipment, known as interspinous spacer devices and minimally invasive lumbar decompression (MILD). Most studies offering a comparative analysis have demonstrated that surgical intervention is more efficacious than non-surgical interventions to manage pain associated with spinal stenosis.
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Affiliation(s)
- Kashif N Malik
- Physical Medicine and Rehabilitation, Casa Colina Hospital, Pomona, USA
| | - Curren Giberson
- Physical Medicine and Rehabilitation, Casa Colina Hospital, Pomona, USA
| | - Matthew Ballard
- Physical Medicine and Rehabilitation, Casa Colina Hospital, Pomona, USA
| | - Nathan Camp
- Physical Medicine and Rehabilitation, Casa Colina Hospital, Pomona, USA
| | - Justin Chan
- Physical Medicine and Rehabilitation, Western University of Health Sciences, Pomona, USA
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Validity of outcome measures used in randomized clinical trials and observational studies in degenerative lumbar spinal stenosis. Sci Rep 2023; 13:1068. [PMID: 36658179 PMCID: PMC9852241 DOI: 10.1038/s41598-022-27218-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 12/28/2022] [Indexed: 01/20/2023] Open
Abstract
It is unclear whether outcome measures used in degenerative lumbar spinal stenosis (DLSS) have been validated for this condition. Cross-sectional analysis of studies for DLSS included in systematic reviews (SA) and meta-analyses (MA) indexed in the Cochrane Library. We extracted all outcome measures for pain and disability. We assessed whether the studies provided external references for the validity of the outcome measures and the quality of the validation studies. Out of 20 SA/MA, 95 primary studies used 242 outcome measures for pain and/or disability. Most commonly used were the VAS (n = 69), the Oswestry Disability Index (n = 53) and the Zurich Claudication Questionnaire (n = 22). Although validation references were provided in 45 (47.3%) primary studies, only 14 validation studies for 9 measures (disability n = 7, pain and disability combined n = 2) were specifically validated in a DLSS population. The quality of the validation studies was mainly poor. The Zurich Claudication Questionnaire was the only disease specific tool with adequate validation for assessing treatment response in DLSS. To compare results from clinical studies, outcome measures need to be validated in a disease specific population. The quality of validation studies need to be improved and the validity in studies adequately cited.
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Byvaltsev VA, Kalinin AA, Pestryakov YY, Spiridonov AV. [Analysis of preoperative risk factors of adjacent segment disease after transforaminal lumbar interbody fusion]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2023; 87:48-55. [PMID: 37011328 DOI: 10.17116/neiro20238702148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
Currently, there is no information on the combined effect of body mass index (BMI), age, gender, main spinal-pelvic parameters and parameters of adjacent functional spinal unit (FSU) degeneration according to magnetic resonance imaging on development of adjacent segment degenerative disease (ASDd). OBJECTIVE To evaluate the effect of preoperative biometric and instrumental parameters of adjacent FSU on the risk of ASDd after transforaminal lumbar interbody fusion and determine personalized neurosurgical approach. MATERIAL AND METHODS We retrospectively studied patients after single-level transforaminal lumbar interbody fusion (group I, n=54), single-level transforaminal lumbar interbody fusion and interspinous stabilization of adjacent level (group II, n=55), preventive rigid fusion of adjacent segment (group III, n=56). Preoperative parameters and long-term clinical outcomes were assessed. RESULTS Paired correlation analysis established the main predictors of ASDd. Regression analysis determined absolute values of these predictors for each type of surgical intervention. CONCLUSION Surgical intervention at the level of asymptomatic proximal adjacent segment is recommended as interspinous stabilization for moderate degenerative lesions, BMI <25 kg/m2, difference between pelvic index and lumbar lordosis 10.5-15°, segmental lordosis 6.5-10.5°. In case of severe degenerative lesions, BMI 25.1-31.1 kg/m2, significant deviations of spinal-pelvic parameters (segmental lordosis 5.5-10.5°, difference between pelvic index and lumbar lordosis 15.2-20°), preventive rigid stabilization is indicated.
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Affiliation(s)
- V A Byvaltsev
- Irkutsk State Medical University, Irkutsk, Russia
- Russian Railways-Medicine Clinical Hospital, Irkutsk, Russia
- Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russia
| | - A A Kalinin
- Irkutsk State Medical University, Irkutsk, Russia
- Russian Railways-Medicine Clinical Hospital, Irkutsk, Russia
| | - Yu Ya Pestryakov
- Irkutsk State Medical University, Irkutsk, Russia
- Regional Clinical Hospital, Krasnoyarsk, Russia
| | - A V Spiridonov
- Irkutsk State Medical University, Irkutsk, Russia
- Regional Clinical Hospital, Krasnoyarsk, Russia
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Comprehensive analysis of the results of surgical treatment of patients with degenerative diseases of the lumbar spine using rigid fixation systems. ACTA BIOMEDICA SCIENTIFICA 2022. [DOI: 10.29413/abs.2022-7.4.8] [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
Introduction. According to the literature, the development of adjacent-level syndrome 10 years after posterior rigid stabilization is noted in 6.7–80 % of patients, of which 24 % require revision surgery.The aim: to conduct a comprehensive analysis of the results of surgical treatment of patients with degenerative diseases of the lumbar spine using rigid fixation systems.Materials and methods. A multicenter retrospective study of the results of surgical treatment of 268 patients with degenerative-dystrophic diseases of the lumbar spine, who underwent mono- or bisegmental decompression-stabilizing intervention with the implementation of the TLIF (Transforaminal Lumbar Interbody Fusion) technique and open transpedicular rigid fixation, was conducted. The study included radiography, MRI and CT (in 2-energy mode) of intervertebral discs and isolated facet degeneration of the upper adjacent level.Results and discussion. The combination of the initial degeneration of the adjacent spinal motion segment in the form of disc degeneration of grade III and higher according to Pfirrmann with threshold values of the density of the outer cartilaginous plate from 161.7 ± 18.8 to 164.8 ± 14.2 HU, the density of the outer facet – from 702.43 ± 12.3 to 713.65 ± 13.6 HU and the density of the inner facet – from 580.5 ± 11.6 to 582.1 ± 15.1 HU, as well as with signs of segmental instability of the adjacent segment can be considered as risk factors for the development of its degeneration. With the progression of degeneration of the upper intervertebral disc, revision interventions were performed within 12–60 months after surgery.Conclusion. Bisegmental stabilization with signs of initial degeneration in the intervertebral disc and facet joints in the upper segment has proven its clinical and instrumental effectiveness in the period of 36 months and reduces the risks of developing degenerative disease of the adjacent disc.
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12
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Guo Z, Liu G, Wang L, Zhao Y, Zhao Y, Lu S, Cheng C. Biomechanical effect of Coflex and X-STOP spacers on the lumbar spine: a finite element analysis. Am J Transl Res 2022; 14:5155-5163. [PMID: 35958508 PMCID: PMC9360861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 06/09/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To explore the biomechanical differences between Coflex and X-STOP devices by finite element analysis. METHODS Based on the normal lumbar CT images from a healthy adult volunteer, four finite element models including the healthy lumbar segment model, the mild degenerated lumbar segment model, a Coflex fixed lumbar segment model and X-STOP fixed lumbar segment model were constructed. A simulation analysis under the conditions of flexion, extension, lateral bending, and rotation was performed to compare range of motion (ROM), intradiscal pressure, the facet joint force, the maximum Von Mises stress and the peak facet contact forces, between Coflex and X-STOP devices. RESULTS Compared to the mild degenerated lumbar segment model at surgical level L4-L5, Coflex and X-STOP could reduce ROM in extension by 98.34% and 95.86%, respectively, decrease peak stress of intervertebral discs in extension by 59.4% and 66.17%, respectively, and release peak force of facet joint in extension by 97.09% and 95.42%, respectively. Both devices had no significant impact on adjacent levels. The maximum Von Mises stress in Coflex device was 637.56 Mpa in flexion, 528.86 Mpa in extension, while the maximum Von Mises stress in X-STOP device was 476.65 Mpa at extension position. The peak facet contact forces of Coflex and X-STOP devices appeared in extension and were 19.76 Mpa and 49.28 Mpa, respectively. CONCLUSIONS Coflex and X-STOP devices can effectively decrease the ROM and intradiscal pressure in extension, without affecting the adjacent levels.
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Affiliation(s)
- Zhiyuan Guo
- Department of Orthopedics, Cangzhou Central Hospital Cangzhou, Hebei, China
| | - Guangfei Liu
- Department of Orthopedics, Cangzhou Central Hospital Cangzhou, Hebei, China
| | - Lu Wang
- Department of Orthopedics, Cangzhou Central Hospital Cangzhou, Hebei, China
| | - Yuejiang Zhao
- Department of Orthopedics, Cangzhou Central Hospital Cangzhou, Hebei, China
| | - Ye Zhao
- Department of Orthopedics, Cangzhou Central Hospital Cangzhou, Hebei, China
| | - Shouliang Lu
- Department of Orthopedics, Cangzhou Central Hospital Cangzhou, Hebei, China
| | - Cai Cheng
- Department of Orthopedics, Cangzhou Central Hospital Cangzhou, Hebei, China
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13
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Deer TR, Grider JS, Pope JE, Lamer TJ, Wahezi SE, Hagedorn JM, Falowski S, Tolba R, Shah JM, Strand N, Escobar A, Malinowski M, Bux A, Jassal N, Hah J, Weisbein J, Tomycz ND, Jameson J, Petersen EA, Sayed D. Best Practices for Minimally Invasive Lumbar Spinal Stenosis Treatment 2.0 (MIST): Consensus Guidance from the American Society of Pain and Neuroscience (ASPN). J Pain Res 2022; 15:1325-1354. [PMID: 35546905 PMCID: PMC9084394 DOI: 10.2147/jpr.s355285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/06/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Methods Results Discussion Conclusion
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Affiliation(s)
- Timothy R Deer
- Centers for Pain Relief, Charleston, WV, USA
- Correspondence: Timothy R Deer, The Spine and Nerve Centers of the Virginias, 400 Court Street, Suite 100, Charleston, WV, 25301, USA, Tel +1 304 347-6141, Email
| | - Jay S Grider
- UK HealthCare Pain Services, Department of Anesthesiology, University of Kentucky College of Medicine, Lexington, KY, USA
| | | | - Tim J Lamer
- Division of Pain Medicine, Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA
| | - Sayed E Wahezi
- Montefiore Medical Center, SUNY-Buffalo, Buffalo, NY, USA
| | - Jonathan M Hagedorn
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA
| | - Steven Falowski
- Director Functional Neurosurgery, Neurosurgical Associates of Lancaster, Lancaster, PA, USA
| | - Reda Tolba
- Pain Management Department, Anesthesiology Institute, Cleveland Clinic, Abu Dhabi, UAE
| | - Jay M Shah
- SamWell Institute for Pain Management, Colonia, NJ, USA
| | - Natalie Strand
- Department of Anesthesiology, Division of Pain Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Alex Escobar
- Department of Anesthesiology and Pain Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | | | - Anjum Bux
- Bux Pain Management, Lexington, KY, USA
| | | | - Jennifer Hah
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Palo Alto, CA, USA
| | | | - Nestor D Tomycz
- Department of Neurological Surgery, Allegheny General Hospital, Allegheny Health Network, Pittsburgh, PA, USA
| | | | - Erika A Petersen
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Dawood Sayed
- Pain Medicine, Multidisciplinary Pain Fellowship, The University of Kansas Health System, Kansas City, KS, USA
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14
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Florence TJ, Say I, Patel KS, Unterberger A, Laiwalla A, Vivas AC, Lu DC. Neurosurgical Management of Interspinous Device Complications: A Case Series. Front Surg 2022; 9:841134. [PMID: 35372480 PMCID: PMC8965756 DOI: 10.3389/fsurg.2022.841134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 01/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background Best practice guidelines for treating lumbar stenosis include a multidisciplinary approach, ranging from conservative management with physical therapy, medication, and epidural steroid injections to surgical decompression with or without instrumentation. Marketed as an outpatient alternative to a traditional lumbar decompression, interspinous process devices (IPDs) have gained popularity as a minimally invasive stabilization procedure. IPDs have been embraced by non-surgical providers, including physiatrists and anesthesia interventional pain specialists. In the interest of patient safety, it is imperative to formally profile its safety and identify its role in the treatment paradigm for lumbar stenosis. Case Description We carried out a retrospective review at our institution of neurosurgical consultations for patients with hardware complications following the interspinous device placement procedure. Eight cases within a 3-year period were identified, and patient characteristics and management are illustrated. The series describes the migration of hardware, spinous process fracture, and worsening post-procedural back pain. Conclusions IPD placement carries procedural risk and requires a careful pre-operative evaluation of patient imaging and surgical candidacy. We recommend neurosurgical consultation and supervision for higher-risk IPD cases.
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Affiliation(s)
- T. J. Florence
- UCLA Department of Neurosurgery, Los Angeles, CA, United States
| | - Irene Say
- Department of Neurosurgery, University of Massachusetts, Worcester, MA, United States
| | - Kunal S. Patel
- UCLA Department of Neurosurgery, Los Angeles, CA, United States
| | - Ansley Unterberger
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Azim Laiwalla
- UCLA Department of Neurosurgery, Los Angeles, CA, United States
| | - Andrew C. Vivas
- UCLA Department of Neurosurgery, Los Angeles, CA, United States
| | - Daniel C. Lu
- UCLA Department of Neurosurgery, Los Angeles, CA, United States
- *Correspondence: Daniel C. Lu
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15-year survivorship analysis of an interspinous device in surgery for single-level lumbar disc herniation. BMC Musculoskelet Disord 2021; 22:1030. [PMID: 34886816 PMCID: PMC8656107 DOI: 10.1186/s12891-021-04929-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 12/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Interspinous devices have been introduced as alternatives to decompression or fusion in surgery for degenerative lumbar diseases. This study aimed to investigate 15-year survivorship and risk factors for reoperation of a Device for Intervertebral Assisted Motion (DIAM) in surgery for 1-level lumbar disc herniation (LDH). METHODS A total of 94 patients (54 men and 40 women) underwent discectomy and DIAM implantation for 1-level LDH, with a mean follow-up of 12.9 years (range, 6.3-15.3 years). The mean age was 46.2 years (range, 21-65 years). Sixty-two patients underwent DIAM implantation for L4-5, 27 for L5-6, and 5 for L3-4. Reoperations due to any reason associated with DIAM implantation level or adjacent levels were defined as failure and used as the end point of determining survivorship. RESULTS During the 15-year follow-up, 8 patients (4 men and 4 women) underwent reoperation due to recurrence of LDH at the DIAM implantation level, a reoperation rate of 8.5%. The mean time to reoperation was 6.5 years (range, 0.8-13.9 years). Kaplan-Meier analysis showed a cumulative survival rate of the DIAM implantation of 97% at 5 years, 93% at 10 years, and 92% at 15 years after surgery; the cumulative reoperation rate of the DIAM implantation was 3% at 5 years, 7% at 10 years, and 8% at 15 years after surgery. Mean survival time was predicted to be 14.5 years (95% CI, 13.97-15.07). The log-rank test and Cox proportional hazard model showed that age, sex, and location did not significantly affect the reoperation rate of DIAM implantation. CONCLUSIONS Our results showed that DIAM implantation significantly decreased reoperation rate for LDH in the 15-year survivorship analysis. We suggest that DIAM implantation could be considered a useful intermediate step procedure for LDH surgery. To the best of our knowledge, this is the longest follow-up study in which surgical outcomes of interspinous device surgery were reported.
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Zhang J, Liu TF, Shan H, Wan ZY, Wang Z, Viswanath O, Paladini A, Varrassi G, Wang HQ. Decompression Using Minimally Invasive Surgery for Lumbar Spinal Stenosis Associated with Degenerative Spondylolisthesis: A Review. Pain Ther 2021; 10:941-959. [PMID: 34322837 PMCID: PMC8586290 DOI: 10.1007/s40122-021-00293-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 07/12/2021] [Indexed: 11/21/2022] Open
Abstract
Lumbar spinal stenosis (LSS), which often occurs concurrently with degenerative spondylolisthesis (DS), is a common disease in the elderly population, affecting the quality of life of aged people significantly. Notwithstanding the frequently good effect of conservative therapy on LSS, a minority of the patients ultimately require surgery. Surgery for LSS aims to decompress the narrowed spinal canals with preservation of spinal stability. Traditional open surgery, either pure decompression or decompression with fusion, was considered effective for the treatment of LSS with or without DS. However, the long-term clinical outcomes of traditional open surgery are still unclear. Moreover, the disadvantages of conventional open surgery are extensive, examples including tissue injuries or secondary instability, with limited outcomes and significant reoperation rates. With the development and improvement of surgical tools, various minimally invasive spine surgery (MISS) methods, including indirect decompression techniques of interspinous process devices (IPDs) and direct decompression techniques such as microscopic spine surgery or endoscopic spine surgery (ESS), have been updated with enhancement. IPDs, such as Superion devices, were reported to behave with comparable physical function, disability, and symptoms outcomes to laminectomy decompression. As an emerging technique of MISS, ESS has beneficial hallmarks including minimal tissue injuries, reduced complication rates, and shortened recovery periods, thus gaining popularity in recent years. ESS can be classified in terms of endoscopic hallmarks and approaches. Predictably, with the continuous development and gradual maturity, MISS is expected to replace traditional open surgery widely in the surgical treatment of LSS associated with DS in the future.
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Affiliation(s)
- Jun Zhang
- grid.489934.bDepartment of Orthopaedics, Baoji Central Hospital, Baoji, 721008 Shaanxi China ,grid.43169.390000 0001 0599 1243School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, 710061 Shaanxi China
| | - Tang-Fen Liu
- grid.449637.b0000 0004 0646 966XInstitute of Integrative Medicine, Shaanxi University of Chinese Medicine, Xixian District, Xi’an, 712046 Shaanxi China
| | - Hua Shan
- grid.449637.b0000 0004 0646 966XInstitute of Integrative Medicine, Shaanxi University of Chinese Medicine, Xixian District, Xi’an, 712046 Shaanxi China
| | - Zhong-Yuan Wan
- grid.414252.40000 0004 1761 8894Department of Orthopedics, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, 100700 People’s Republic of China
| | - Zhe Wang
- grid.489934.bDepartment of Orthopaedics, Baoji Central Hospital, Baoji, 721008 Shaanxi China
| | - Omar Viswanath
- grid.134563.60000 0001 2168 186XDepartment of Anesthesiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ USA ,grid.64337.350000 0001 0662 7451Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA USA ,Valley Pain Consultants-Envision Physician Services, Phoenix, AZ USA ,grid.254748.80000 0004 1936 8876Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE USA
| | - Antonella Paladini
- grid.158820.60000 0004 1757 2611Department of MESVA, University of L’Aquila, 67100 L’Aquila, Italy
| | | | - Hai-Qiang Wang
- Institute of Integrative Medicine, Shaanxi University of Chinese Medicine, Xixian District, Xi'an, 712046, Shaanxi, China.
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Zhong J, O'Connell B, Balouch E, Stickley C, Leon C, O'Malley N, Protopsaltis TS, Kim YH, Maglaras C, Buckland AJ. Patient Outcomes After Single-level Coflex Interspinous Implants Versus Single-level Laminectomy. Spine (Phila Pa 1976) 2021; 46:893-900. [PMID: 33395022 DOI: 10.1097/brs.0000000000003924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort analysis. OBJECTIVE The aim of this study was to compare postoperative outcomes of Coflex interspinous device versus laminectomy. SUMMARY OF BACKGROUND DATA Coflex Interlaminar Stabilization device (CID) is indicated for one- or two-level lumbar stenosis with grade 1 stable spondylolisthesis in adult patients, as an alternative to laminectomy, or laminectomy and fusion. CID provides stability against progressive spondylolisthesis, retains motion, and prevents further disc space collapse. METHODS Patients ≥18 years' old with lumbar stenosis and grade 1 stable spondylolisthesis who underwent either primary single-level decompression and implantation of CID, or single-level laminectomy alone were included with a minimum 90-day follow-up at a single academic institution. Clinical characteristics, perioperative outcomes, and postoperative complications were reviewed until the latest follow-up. χ2 and independent samples t tests were used for analysis. RESULTS Eighty-three patients (2007-2019) were included: 37 cases of single-level laminectomy (48.6% female) were compared to 46 single-level CID (50% female). CID cohort was older (CID 69.0 ± 9.4 vs. laminectomy 64.2 ± 11.0, P = 0.042) and had higher American Society of Anesthesiologists (ASA) grade (CID 2.59 ± 0.73 vs. laminectomy 2.17 ± 0.48, P = 0.020). CID patients had higher estimated blood loss (EBL) (97.50 ± 77.76 vs. 52.84 ± 50.63 mL, P = 0.004), longer operative time (141.91 ± 47.88 vs. 106.81 ± 41.30 minutes, P = 0.001), and longer length of stay (2.0 ± 1.5 vs. 1.1 ± 1.0 days, P = 0.001). Total perioperative complications (21.7% vs. 5.4%, P = 0.035) and instrumentation-related complication was higher in CID (10.9% vs. 0% laminectomy group, P = 0.039). There were no other significant differences between the groups in demographics or outcomes. CONCLUSION Single-level CID devices had higher perioperative 90-day complications, longer operative time, length of stay, higher EBL compared to laminectomies alone. Similar overall revision and neurologic complication rates were noted compared to laminectomy at last follow-up.Level of Evidence: 3.
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Affiliation(s)
- Jack Zhong
- NYU Langone Health, Department of Orthopedics, Division of Spine, New York, NY
| | - Brooke O'Connell
- NYU Langone Health, Department of Orthopedics, Division of Spine, New York, NY
| | - Eaman Balouch
- NYU Langone Health, Department of Orthopedics, Division of Spine, New York, NY
| | - Carolyn Stickley
- NYU Langone Health, Department of Orthopedics, Division of Spine, New York, NY
| | - Carlos Leon
- NYU Langone Health, Department of Orthopedics, Division of Spine, New York, NY
| | - Nicholas O'Malley
- NYU Langone Health, Department of Orthopedics, Division of Spine, New York, NY
| | | | - Yong H Kim
- NYU Langone Health, Department of Orthopedics, Division of Spine, New York, NY
| | - Constance Maglaras
- NYU Langone Health, Department of Orthopedics, Division of Spine, New York, NY
| | - Aaron J Buckland
- NYU Langone Health, Department of Orthopedics, Division of Spine, New York, NY
- Melbourne Orthopedic Group, Melbourne, Australia
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Sunderland G, Foster M, Dheerendra S, Pillay R. Patient-Reported Outcomes Following Lumbar Decompression Surgery: A Review of 2699 Cases. Global Spine J 2021; 11:172-179. [PMID: 32875849 PMCID: PMC7882820 DOI: 10.1177/2192568219896541] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
STUDY DESIGN Retrospective case series. OBJECTIVE Despite numerous advances in the technology and techniques available to spinal surgeons, lumbar decompression remains the mainstay of degenerative lumbar spine surgery. It has proven efficacy in trials, but only limited evidence of advantage over conservative management in large scale systematic reviews. We collated data from a large surgically managed cohort to evaluate the patient-reported outcomes. METHODS We performed a retrospective analysis of a prospectively populated database. Patient demographics, surgical details, and patient outcomes (Spine Tango core outcome measures index [COMI]-Low Back) were collected for 2699 lumbar decompression surgeries. RESULTS Lumbar decompression was shown to be successful at improving leg pain (mean improvement in visual analogue scale [VAS] at 3 months = 4) and to a lesser extent, back pain (mean improvement in VAS at 3 months = 2.61). Mean improvement in COMI score was 3.15 for all-comers. Minimal clinically important improvement (MCID) in COMI score (-2 points) was achieved in 73% of patients by 2-year follow-up. Primary surgery was more effective than redo surgery: odds ratio 0.547 (95% CI 0.408-0.733, P < .001). The benefits across all outcomes were maintained for the 2-year follow-up period. Patients can be classified according to their outcome as "early responders"; achieving MCID by 3 months (61% primary vs 41% redo), "late responders"; achieving MCID by 2 years (15% vs 20%) or nonresponders (24% vs 39%). CONCLUSIONS Lumbar decompression is effective in improving quality of life in appropriately selected patients. Patient-reported outcome measures collected routinely and collated within a registry are a powerful tool for assessing the efficacy of lumbar spine interventions and allow accurate counseling of patients perioperatively.
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Affiliation(s)
| | | | - Sujay Dheerendra
- The Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, UK
| | - Robin Pillay
- The Walton Centre NHS Foundation Trust, Liverpool, UK
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Welton L, Krieg B, Trivedi D, Netsanet R, Wessell N, Noshchenko A, Patel V. Comparison of Adverse Outcomes Following Placement of Superion Interspinous Spacer Device Versus Laminectomy and Laminotomy. Int J Spine Surg 2021; 15:153-160. [PMID: 33900969 DOI: 10.14444/8020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Current evidence suggests placement of the Superion interspinous spacer (SISS) device compared with laminectomy or laminotomy surgery offers an effective, less invasive treatment option for patients with symptomatic lumbar spinal stenosis. Both SISS placement and laminectomy or laminotomy have risks of complications and a direct comparison of complications between the 2 procedures has not been previously studied. The purpose of this study is to compare the short-term complications of the SISS with laminectomy or laminotomy and highlight device-specific long-term outcomes with SISS. METHODS Via retrospective review, 189 patients who received lumbar level SISSs were compared with 378 matched controls who underwent primary lumbar spine laminectomy or laminotomy; data were collected from the American College of Surgeons National Surgical Quality Improvement Program database. Complications analyzed included rates of wound infection, pulmonary embolism, deep venous thrombosis, urinary tract infection, sepsis, septic shock, cardiac arrest, death, and reoperation within 30 days of index surgery. Differences between groups were analyzed using the χ2test. Device-specific complication (DSC) rates included device malfunction or misplacement (DM), device explantation (DE), spinous process fracture (SPF), and subsequent spinal surgery (SSS). RESULTS No differences in demographics or comorbidities existed between groups. There was no significant difference in rates of complications between groups. A total of 44.4% of patients in the SISS group experienced DSCs with 11.1% of patients experiencing DM, 21.1% experiencing an SPF, 20.1% requiring DE, and 24.3% requiring SSS. Having at least 1 DSC significantly increased odds of SSS, odds ratio >120, P < .0001. CONCLUSION Rates of 30-day complications in the SISS group were not significantly different from patients undergoing laminectomy or laminotomy. Rates of 2-year DSC within SISS and cumulative risk associated with these complications should be considered further as they likely represent need for additional procedures for patients and substantial cost to the healthcare system. LEVEL OF EVIDENCE 4. CLINICAL RELEVANCE Having no differences in adverse events between laminectomies or laminotomies and SISS plus evidence of substantial device-specific long-term adverse outcomes and reoperation should be given consideration when deciding on surgical intervention of 1-2 level lumbar spinal stenosis.
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Affiliation(s)
- Lindsay Welton
- University of Minnesota School of Medicine Department of Surgery, Division of General Surgery, Minneapolis, Minnesota
| | - Brandi Krieg
- University of Colorado School of Medicine, Aurora, Colorado
| | - Deepa Trivedi
- University of Colorado School of Public Health, Aurora, Colorado
| | - Rahwa Netsanet
- University of Colorado School of Medicine Department of Orthopedic Surgery, Division of Spine Surgery, Aurora, Colorado
| | - Nolan Wessell
- University of Colorado School of Medicine Department of Orthopedic Surgery, Division of Spine Surgery, Aurora, Colorado
| | - Andriy Noshchenko
- University of Colorado School of Medicine Department of Orthopedic Surgery, Division of Spine Surgery, Aurora, Colorado
| | - Vikas Patel
- University of Colorado School of Medicine Department of Orthopedic Surgery, Division of Spine Surgery, Aurora, Colorado
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Segura-Trepichio M, Pérez-Maciá MV, Candela-Zaplana D, Nolasco A. Lumbar disc herniation surgery: Is it worth adding interspinous spacer or instrumented fusion with regard to disc excision alone? J Clin Neurosci 2021; 86:193-201. [PMID: 33775327 DOI: 10.1016/j.jocn.2021.01.035] [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: 01/03/2021] [Accepted: 01/21/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Discectomy is sometimes associated with recurrence of disc herniation and pain after surgery. The evidence to use an interspinous dynamic stabilization system or instrumented fusion in association with disc excision to prevent pain and re-operation remains controversial. In this study, we analyzed if adding interspinous spacer or fusion, offers advantages in relation to microdiscetomy alone. METHODS Patients with lumbar disc herniation were divided in 3 groups; microdiscectomy alone (MD), microdiscectomy plus interspinous spacer (IS) and open discectomy plus posterior lumbar interbody fusion (PLIF). The clinical efficacy was measured using the Owestry Disability Index (ODI). Other outcome parameters including visual analogue scale for pain (VAS) back and legs, length of stay, direct in-hospital cost, 90-day complication rate, and 1-year re-operation rate were also evaluated. RESULTS A total of 103 patients whose mean age was 39.1 (±8.5) years were included. A significant improvement of the ODI and VAS back and legs pain baseline score was detected in the 3 groups. After 1 year, no significant differences in ODI, VAS back and legs pain were found between the 3 groups. There was an increase of 169% of the total direct in- hospital cost in IS group and 287% in PLIF group, in relation to MD (p < 0.001). Length of stay was 86% higher in the IS group and 384% longer in the PLIF group compared to MD (p < 0.001). The 1 year re-operation rates were 5.6%, 10% and 16.2% (p = 0.33). Discectomy seems to be the main responsible for the clinical improvement, without the interspinous spacer or fusion adding any benefit. The addition of interspinous spacer or fusion increased direct in-hospital cost, length of stay, and did not protect against re-operation.
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Affiliation(s)
| | | | - David Candela-Zaplana
- Departamento de Medicina Familiar y Comunitaria, Hospital del Vinalopó, Alicante, Spain
| | - Andreu Nolasco
- Unidad de investigacion para el análisis de las desigualdades en salud y la mortalidad FISABIO-UA, Universidad de Alicante, Alicante, Spain
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21
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Li CY, Chen MY, Chang CN, Yan JL. Three-Dimensional Volumetric Changes and Clinical Outcomes after Decompression with DIAM™ Implantation in Patients with Degenerative Lumbar Spine Diseases. ACTA ACUST UNITED AC 2020; 56:medicina56120723. [PMID: 33371350 PMCID: PMC7767335 DOI: 10.3390/medicina56120723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 12/22/2022]
Abstract
Background and objectives: The prevalence of degenerative lumbar spine diseases has increased. In addition to standard lumbar decompression and/or fusion techniques, implantation of interspinous process devices (IPDs) can provide clinical benefits in highly selected patients. However, changes in spinal structures after IPD implantation using magnetic resonance imaging (MRI) have rarely been discussed. This volumetric study aimed to evaluate the effect of IPD implantation on the intervertebral disc and foramen using three-dimensional assessment. Materials and Methods: We retrospectively reviewed patients with lumbar degenerative disc diseases treated with IPD implantation and foraminotomy and/or discectomy between January 2016 and December 2019. The mean follow-up period was 13.6 months. The perioperative lumbar MRI data were processed for 3D-volumetric analysis. Clinical outcomes, including the Prolo scale and visual analog scale (VAS) scores, and radiographic outcomes, such as the disc height, foraminal area, and translation, were analyzed. Results: Fifty patients were included in our study. At the one-year follow-up, the VAS and Prolo scale scores significantly improved (both p < 0.001). The disc height and foraminal area on radiographs also increased significantly, but with limited effects up to three months postoperatively. MRI revealed an increased postoperative disc height with a mean difference of 0.5 ± 0.1 mm (p < 0.001). Although the mean disc volume difference did not significantly increase, the mean foraminal volume difference was 0.4 ± 0.16 mm3 (p < 0.05). Conclusions: In select patients with degenerative disc diseases or lumbar spinal stenosis, the intervertebral foramen was enlarged, and disc loading was reduced after IPD implantation with decompression surgery. The 3D findings were compatible with the clinical benefits.
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Affiliation(s)
- Cheng-Yu Li
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan 33302, Taiwan; (C.-Y.L.); (C.-N.C.)
| | - Mao-Yu Chen
- Department of Neurosurgery, Keelung Chang Gung Memorial Hospital, Keelung 20401, Taiwan;
| | - Chen-Nen Chang
- Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan 33302, Taiwan; (C.-Y.L.); (C.-N.C.)
| | - Jiun-Lin Yan
- Department of Neurosurgery, Keelung Chang Gung Memorial Hospital, Keelung 20401, Taiwan;
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Correspondence: ; Tel.: +886-2-24313131
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Badve SA, Kurra S, Geisler FH, Metkar U, Tallarico R, Lavelle W. Nerve Root Sedimentation Sign: Can It Predict the Success for Surgical Intervention in Patients With Symptomatic Lumbar Spinal Stenosis? Cureus 2020; 12:e9803. [PMID: 32953315 PMCID: PMC7494419 DOI: 10.7759/cureus.9803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION The use of interspinous process devices are less invasive surgical methods designed to manage mild to moderate lumbar spinal stenosis symptoms. Symptomatic relief may not be seen in all patients undergoing this procedure. Magnetic resonance imaging (MRI) parameters have been used to predict the success of clinical outcomes in patients with symptomatic lumbar spinal stenosis for decompressive surgeries. The purpose of this study was to determine the feasibility of using nerve root sedimentation sign to predict mid- to long-term clinical outcomes of patients treated with interspinous spacers for lumbar spinal stenosis. METHODS This was a retrospective study using prospective multicenter Food and Drug Administration Investigational Device Exemption (FDA IDE) trial (Superion™ and X-STOP®) data. Inclusion criteria were patients treated with interspinous spacers, aged 45 or older with lumbar spinal stenosis at one or more contiguous levels from L1 to L5 and symptoms of neurogenic claudication. Preoperative axial T2 weighted MRI images were used to determine nerve root sedimentation sign. Preoperative, six-week, one- and two-year postoperative clinical outcomes were measured using Oswestry Disability Index (ODI) scores. Clinical outcomes were compared between positive and negative nerve root sedimentation sign groups; p ≤0.05 was considered significant. RESULTS This study included n=374 patients; 40 excluded; 334 included (113=positive nerve root sedimentation sign (NRSS) (34%) and 221=negative NRSS (66%)). At six weeks, significant postoperative ODI correction was noted in both groups (p<0.001). No significant differences in ODI scores were identified between groups. A subgroup analysis with MRI image quality grade 3 and certainty determination grade 5, six-week postoperative ODI correction was significant in both groups. Six-week, one- and two-year postoperative ODI scores were greater by 6 points in the positive nerve root sedimentation sign group compared to the negative nerve root sedimentation sign group. CONCLUSIONS Although satisfactory postoperative improvement occurred in both groups, there were statistically significant differences noted in certain sub-categories. The subgroup analysis indicated MRI image quality and nerve root sedimentation sign certainty of determination may be factors that may aid with planning the surgical management of lumbar spinal stenosis.
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Affiliation(s)
| | - Swamy Kurra
- Orthopedic Surgery, State University of New York Upstate Medical University, Syracuse, USA
| | - Fred H Geisler
- Medical Imaging, College of Medicine at the University of Saskatchewan, Saskatoon, CAN
| | - Umesh Metkar
- Orthopedics, The Spine Center at Beth Israel Deaconess Medical Center, Boston, USA
| | - Richard Tallarico
- Orthopedic Surgery, State University of New York Upstate Medical University, Syracuse, USA
| | - William Lavelle
- Orthopedic Surgery, State University of New York Upstate Medical University, Syracuse, USA
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Toth JM, Bric JD. An evaluation of the host response to an interspinous process device based on a series of spine explants: Device for Intervertebral Assisted Motion (DIAM ®). JOURNAL OF SPINE SURGERY 2020; 5:483-495. [PMID: 32042999 DOI: 10.21037/jss.2019.10.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The objective of this study was to evaluate the host response to an interspinous process device [Device for Intervertebral Assisted Motion (DIAM®)] based on a series of nine spine explants with a mean post-operative explant time of 35 months. Methods Explanted periprosthetic tissues were processed for histology and stained with H&E, Wright-Giemsa stain, and Oil Red O. Brightfield and polarized light microscopy were used to evaluate the host response to the device and the resultant particulate debris. The host response was graded per ASTM F981-04. Quantitative histomorphometry was used to characterize particle size, shape, and area per ASTM F1877-05. The presence or absence of bone resorption was also evaluated when bony tissue samples were provided. Results Periprosthetic tissues demonstrated a non-specific foreign body response composed of macrophages and foreign body giant cells to the DIAM® device in most of the accessions. The foreign body reaction was not the stated reason for explantation in any of the accessions. Per ASTM F981-04, a "very slight" to "mild" to "moderate" chronic inflammatory response was observed to the biomaterials and particulate, and this varied by tissue sample and accession. Particle sizes were consistent amongst the explant patients with mean particle size on the order of several microns. Osteolysis, signs of toxicity, necrosis, an immune response, and/or device related infection were not observed. Conclusions Cyclic loading of the spine can cause wear in dynamic stabilization systems such as DIAM®. The fabric nature of the DIAM® device's polyethylene terephthalate jacket coupled with the generation of polymeric particulate debris predisposes the device to a foreign body reaction consisting of macrophages and foreign body giant cells. Although not all patients are aware of symptoms associated with a foreign body reaction to a deeply implanted device, surgeons should be aware of the host response to this device.
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Affiliation(s)
- Jeffrey M Toth
- Department of Orthopaedic Surgery, The Medical College of Wisconsin Inc., Milwaukee, WI, USA.,Orthopaedic & Rehabilitation Engineering Center and Graduate Program in Dental Biomaterials, Marquette University, Milwaukee, WI, USA
| | - Justin D Bric
- Department of Orthopaedic Surgery, The Medical College of Wisconsin Inc., Milwaukee, WI, USA
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Biomechanical Analysis of Different Lumbar Interspinous Process Devices: A Finite Element Study. World Neurosurg 2019; 127:e1112-e1119. [DOI: 10.1016/j.wneu.2019.04.051] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 04/03/2019] [Accepted: 04/04/2019] [Indexed: 12/27/2022]
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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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Poetscher AW, Gentil AF, Ferretti M, Lenza M. Interspinous process devices for treatment of degenerative lumbar spine stenosis: A systematic review and meta-analysis. PLoS One 2018; 13:e0199623. [PMID: 29979691 PMCID: PMC6034833 DOI: 10.1371/journal.pone.0199623] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 05/03/2018] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Degenerative lumbar spinal stenosis is a condition related to aging in which structural changes cause narrowing of the central canal and intervertebral foramen. It is currently the leading cause for spinal surgery in patients over 65 years. Interspinous process devices (IPDs) were introduced as a less invasive surgical alternative, but questions regarding safety, efficacy, and cost-effectiveness are still unanswered. OBJECTIVES The aim of this study was to provide complete and reliable information regarding benefits and harms of IPDs when compared to conservative treatment or decompression surgery and suggest directions for forthcoming RCTs. METHODS We searched MEDLINE, EMBASE, Cochrane Library, Scopus, and LILACS for randomized and quasi-randomized trials, without language or period restrictions, comparing IPDs to conservative treatment or decompressive surgery in adults with symptomatic degenerative lumbar spine stenosis. Data extraction and analysis were conducted following the Cochrane Handbook. Primary outcomes were pain assessment, functional impairment, Zurich Claudication Questionnaire, and reoperation rates. Secondary outcomes were quality of life, complications, and cost-effectiveness. This systematic review was registered at Prospero (International prospective register of systematic reviews) under number 42015023604. RESULTS The search strategy resulted in 17 potentially eligible reports. At the end, nine reports were included and eight were excluded. Overall quality of evidence was low. One trial compared IPDs to conservative treatment: IPDs presented better pain, functional status, quality of life outcomes, and higher complication risk. Five trials compared IPDs to decompressive surgery: pain, functional status, and quality of life had similar outcomes. IPD implant presented a significantly higher risk of reoperation. We found low-quality evidence that IPDs resulted in similar outcomes when compared to standard decompression surgery. Primary and secondary outcomes were not measured in all studies and were often published in incomplete form. Subgroup analysis was not feasible. Difficulty in contacting authors may have prevented us of including data in quantitative analysis. CONCLUSIONS Patients submitted to IPD implants had significantly higher rates of reoperation, with lower cost-effectiveness. Future trials should improve in design quality and data reporting, with longer follow-up periods.
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Affiliation(s)
| | | | - Mario Ferretti
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Mario Lenza
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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Ramhmdani S, Comair M, Molina CA, Sciubba DM, Bydon A. Coflex interspinous implant placement leading to synovial cyst development: case report. J Neurosurg Spine 2018; 29:265-270. [PMID: 29905520 DOI: 10.3171/2018.1.spine171360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Interspinous process devices (IPDs) have been developed as less-invasive alternatives to spinal fusion with the goal of decompressing the spinal canal and preserving segmental motion. IPD implantation is proposed to treat symptoms of lumbar spinal stenosis that improve during flexion. Recent indications of IPD include lumbar facet joint syndrome, which is seen in patients with mainly low-back pain. Long-term outcomes in this subset of patients are largely unknown. The authors present a previously unreported complication of coflex (IPD) placement: the development of a large compressive lumbar synovial cyst. A 64-year-old woman underwent IPD implantation (coflex) at L4-5 at an outside hospital for low-back pain that occasionally radiates to the right leg. Postoperatively, her back and right leg pain persisted and worsened. MRI was repeated and showed a new, large synovial cyst at the previously treated level, severely compressing the patient's cauda equina. Four months later, she underwent removal of the interspinous process implant, bilateral laminectomy, facetectomy, synovial cyst resection, interbody fusion, and stabilization. At the 3-month follow-up, she reported significant back pain improvement with some residual leg pain. This case suggests that facet arthrosis may not be an appropriate indication for placement of coflex.
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Affiliation(s)
- Seba Ramhmdani
- 1The Spinal Column Biomechanics and Surgical Outcomes Laboratory and.,2Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Marc Comair
- 3Georgetown University, Georgetown College, Washington, DC
| | - Camilo A Molina
- 1The Spinal Column Biomechanics and Surgical Outcomes Laboratory and.,2Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Daniel M Sciubba
- 1The Spinal Column Biomechanics and Surgical Outcomes Laboratory and.,2Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Ali Bydon
- 1The Spinal Column Biomechanics and Surgical Outcomes Laboratory and.,2Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
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Laratta JL, Reddy H, Lombardi JM, Shillingford JN, Saifi C, Fischer CR, Lehman RA, Lenke LG. Utilization of Interspinous Devices Throughout the United States Over a Recent Decade: An Analysis of the Nationwide Inpatient Sample. Global Spine J 2018; 8:382-387. [PMID: 29977724 PMCID: PMC6022960 DOI: 10.1177/2192568217731336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
STUDY DESIGN Retrospective database study. OBJECTIVES Analysis of economic and demographic data concerning interspinous device (ID) placement throughout the United States to improve value-based care and health care utilization. METHODS The National Inpatient Sample (NIS) database was queried for patients who underwent insertion of an interspinous process spinal stabilization device (ICD-9-CM 84.80) between 2008 and 2014 across 44 states. Demographic and economic data were obtained which included the annual number of surgeries, age, sex, insurance type, location, and frequency of routine discharge. The NIS database represents a 20% sample of discharges from US hospitals, which is weighted to provide national estimates. RESULTS There was a 73% decrease in ID implanted from 2008 to 2014. The mean cost associated with insertion of the device increased 28% from $13 653 in 2008 to $17 515 in 2014. The mean length of stay (LOS) increased from 1.8 to 2.4 days. Patients aged 45 to 64 years increased from 14.1% to 34.3% while patients aged 65 to 84 years decreased from 74.4% to 60.6%. By region, 34% of ID placement occurred in the South followed by 19.7% that occured in the Northeast. When stratifying by median income for patient zip code, the procedure was performed more in cities designated as higher rather than lower income areas (74.2% and 19.5%, respectively). CONCLUSIONS Throughout the United States, there was a progressive decline in the insertion of interspinous spacers by 73% over the study period. The total costs for the procedure increased by 28% while the aggregate national charges decreased by 55.6% between 2008 and 2014.
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Affiliation(s)
- Joseph L. Laratta
- Columbia University Medical Center, The Spine Hospital at New York–Presbyterian, New York, NY, USA,Joseph L. Laratta, Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York–Presbyterian, 5141 Broadway, 3 Field West, New York, NY 10034, USA.
| | - Hemant Reddy
- Columbia University Medical Center, The Spine Hospital at New York–Presbyterian, New York, NY, USA
| | - Joseph M. Lombardi
- Columbia University Medical Center, The Spine Hospital at New York–Presbyterian, New York, NY, USA
| | - Jamal N. Shillingford
- Columbia University Medical Center, The Spine Hospital at New York–Presbyterian, New York, NY, USA
| | - Comron Saifi
- Rush University Medical Center, Chicago, IL, USA
| | - Charla R. Fischer
- Hospital for Joint Diseases at New York University, New York, NY, USA
| | - Ronald A. Lehman
- Columbia University Medical Center, The Spine Hospital at New York–Presbyterian, New York, NY, USA
| | - Lawrence G. Lenke
- Columbia University Medical Center, The Spine Hospital at New York–Presbyterian, New York, NY, USA
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Fishchenko IV, Kravchuk LD, Perepechay OA. Lumbar spinal stenosis: symptoms, diagnosis and treatment (meta-analysis of literature data). PAIN MEDICINE 2018. [DOI: 10.31636/pmjua.v3i1.83] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Lumbar spinal stenosis is a disease in which degenerated discs, ligamentum flavum, facet joints, while aging, lead to a narrowing of the space around the neurovascular structures of the spine. This article presents a meta-analysis of literature data on epidemiology, causes, pathogenesis, diagnosis and various types of treatment of lumbar spinal stenosis.
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Zhao H, Duan LJ, Gao YS, Yang YD, Zhao DY, Tang XS, Hu ZG, Li CH, Chen SX, Liu T, Yu X. Comparison of two FDA-approved interspinous spacers for treatment of lumbar spinal stenosis: Superion versus X-STOP-a meta-analysis from five randomized controlled trial studies. J Orthop Surg Res 2018; 13:42. [PMID: 29499734 PMCID: PMC5833043 DOI: 10.1186/s13018-018-0742-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 02/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Decompressive laminectomy (DI) is a standard operation for lumbar spinal stenosis (LSS) patient with severe claudication symptoms for many years. However, patients whose symptom severity does not meet undergoing invasive surgery make therapeutic options into dilemma. Interspinous spacers (ISP) bridge the gap between surgical interventions and CC in management of LSS. In our study, we aim to systematically assess the two FDA-approved interspinous spacers for treatment of lumbar spinal stenosis: Superion versus X-STOP. METHODS Electronic databases, including PubMed, Embase, MEDLINE, Cochrane Library were searched to retrieve clinical trials concerning the comparison between Superion and X-STOP in treatment for lumbar spinal stenosis before April 2017. The following outcome measures were extracted: (1) Zurich Claudication Questionnaire (ZCQ) patient satisfaction score, (2) axial pain severity, (3) extremity pain severity, (4) back-specific functional impairment, (5) reoperation, and (6) complication. The data analysis was conducted with Review Manager 5.3. RESULTS Five randomized controlled trials (RCTs) with 1118 patients were included in this meta-analysis. The pooled analysis indicated that the Superion group is superior to X-STOP in axial pain severity (SMD: 0.03; 95% CI 0.15, 0.45; p < 0.0001, I2 = 41%, p = 0.16), ZCQ patient satisfaction score (SMD: 0.23; 95% CI 0.08, 0.38; p = 0.002, I2 = 0%, p = 0.61). However, Superion group showed similarity outcome in extremity pain severity (SMD: 0.18; 95% CI - 0.06, 0.43; p = 0.14, I2 = 62%, p = 0.05), back-specific functional impairment (SMD: 0.04; 95% CI - 0.10, 0.19; p = 0.56, I2 = 0%, p = 0.77), reoperation rate (RR: 1.10; 95% CI 0.82, 1.48; p = 0.51, I2 = 19%, p = 0.30), and complication (RR: 0.98; 95% CI 0.63, 1.53; p = 0.92, I2 = 0%, p = 0.83). CONCLUSION Both the Superion and X-STOP interspinous spacers can relieve symptoms of LSS. In addition, the Superion spacer may represent a promising spacer for patient with LSS. As we know, the effectiveness and safety of ISP is still considered investigational and unfavor clinical results in the medical literature may continue to limit the appeal of IPS to many surgeons in the future. However, because of the advantage of IPS technique, it will win a wide place in the future degenerative lumbar microsurgery.
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Affiliation(s)
- He Zhao
- Department of Orthopedics III, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, No. 5 Haiyuncang Street, Dongcheng District, Beijing, 100700, China
| | - Li-Jun Duan
- Department of Orthopedics, Bayannaoer City Hospital, No. 98 Wulanbuhe Street, Lin He District, Bayannaoer, 015000, China
| | - Yu-Shan Gao
- School of Basic Medical Sciences, Beijing University of Chinese Medicine, No. 11 East Road North 3rd Ring, Chao Yang District, Beijing, 100029, China
| | - Yong-Dong Yang
- Department of Orthopedics III, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, No. 5 Haiyuncang Street, Dongcheng District, Beijing, 100700, China
| | - Ding-Yan Zhao
- Department of Orthopedics III, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, No. 5 Haiyuncang Street, Dongcheng District, Beijing, 100700, China
| | - Xiang-Sheng Tang
- Department of Orthopedics, China-Japan Friendship Hospital Affiliated to Beijing University of Chinese Medicine, No. 11 East Road North 3rd Ring, Chao Yang District, Beijing, 100029, China
| | - Zhen-Guo Hu
- Department of Orthopedics III, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, No. 5 Haiyuncang Street, Dongcheng District, Beijing, 100700, China
| | - Chuan-Hong Li
- Department of Orthopedics III, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, No. 5 Haiyuncang Street, Dongcheng District, Beijing, 100700, China
| | - Si-Xue Chen
- Department of Orthopedics III, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, No. 5 Haiyuncang Street, Dongcheng District, Beijing, 100700, China
| | - Tao Liu
- Department of Orthopedics III, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, No. 5 Haiyuncang Street, Dongcheng District, Beijing, 100700, China
| | - Xing Yu
- Department of Orthopedics III, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, No. 5 Haiyuncang Street, Dongcheng District, Beijing, 100700, China.
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Más Y, Gracia L, Ibarz E, Gabarre S, Peña D, Herrera A. Finite element simulation and clinical follow-up of lumbar spine biomechanics with dynamic fixations. PLoS One 2017; 12:e0188328. [PMID: 29186157 PMCID: PMC5706716 DOI: 10.1371/journal.pone.0188328] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 11/03/2017] [Indexed: 12/16/2022] Open
Abstract
Arthrodesis is a recommended treatment in advanced stages of degenerative disc disease. Despite dynamic fixations were designed to prevent abnormal motions with better physiological load transmission, improving lumbar pain and reducing stress on adjacent segments, contradictory results have been obtained. This study was designed to compare differences in the biomechanical behaviour between the healthy lumbar spine and the spine with DYNESYS and DIAM fixation, respectively, at L4-L5 level. Behaviour under flexion, extension, lateral bending and axial rotation are compared using healthy lumbar spine as reference. Three 3D finite element models of lumbar spine (healthy, DYNESYS and DIAM implemented, respectively) were developed, together a clinical follow-up of 58 patients operated on for degenerative disc disease. DYNESYS produced higher variations of motion with a maximum value for lateral bending, decreasing intradiscal pressure and facet joint forces at instrumented level, whereas screw insertion zones concentrated stress. DIAM increased movement during flexion, decreased it in another three movements, and produced stress concentration at the apophyses at instrumented level. Dynamic systems, used as single systems without vertebral fusion, could be a good alternative to degenerative disc disease for grade II and grade III of Pfirrmann.
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Affiliation(s)
- Yolanda Más
- Department of Mechanical Engineering, University of Zaragoza, Zaragoza, Spain
| | - Luis Gracia
- Department of Mechanical Engineering, University of Zaragoza, Zaragoza, Spain
- Aragón Institute of Engineering Research, Zaragoza, Spain
| | - Elena Ibarz
- Department of Mechanical Engineering, University of Zaragoza, Zaragoza, Spain
- Aragón Institute of Engineering Research, Zaragoza, Spain
| | - Sergio Gabarre
- Department of Mechanical Engineering, University of Zaragoza, Zaragoza, Spain
| | - Diego Peña
- Spine Unit, Department of Orthopaedic Surgery and Traumatology, Miguel Servet University Hospital, Zaragoza, Spain
- Aragón Health Research Institute, Zaragoza, Spain
| | - Antonio Herrera
- Aragón Institute of Engineering Research, Zaragoza, Spain
- Aragón Health Research Institute, Zaragoza, Spain
- Department of Surgery, School of Medicine, University of Zaragoza, Zaragoza, Spain
- * E-mail:
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Segura-Trepichio M, Candela-Zaplana D, Montoza-Nuñez JM, Martin-Benlloch A, Nolasco A. Length of stay, costs, and complications in lumbar disc herniation surgery by standard PLIF versus a new dynamic interspinous stabilization technique. Patient Saf Surg 2017; 11:26. [PMID: 29201144 PMCID: PMC5701374 DOI: 10.1186/s13037-017-0141-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 11/13/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The number of lumbar spine surgeries has been increasing during the last 20 years, which also leads to an increase in hospital costs and complications related to surgery. Therefore, there is a greater concern about the costs and safety of the techniques and implants used. METHODS Patients (aged from 18 to 50 years) presenting with lumbago /sciatica (ICD-10-CM M54.3, M54.4) due to lumbar disc herniation lasting more than 12 weeks, were included. Patients with disc herniation larger than size-2 or size-3 according to the MSU Classification were eligible for participation. Intervention was divided in two groups. In Group 1, patients underwent microdiscectomy and Interspinous Dynamic Stabilization System (IDSS). Meanwhile, in Group 2, patients received discectomy and posterior lumbar interbody fusion (PLIF). The primary outcome measure was the length of stay and costs during hospital admission. We also evaluated several other outcome parameters, including 90- day readmission rate, 90-day complication rate, and re-operations rate. The study was an observational prospective cohort study carried out from January 2015 to August 2016 in which two surgical techniques were compared. Our hypothesis was that a less aggressive procedure, such as discectomy and DSS, will decrease the length of stay and costs, and that it will also reduce the rate of complications with respect to PLIF. RESULTS A total of 67 patients (mean age 39.8 ± 8.4 years) were included. Patients in the PLIF group had a length of stay increase of 109% (4.52 ± 1.76 days vs 2.16 ± 1.18 days p < 0.001) and an in-hospital cost increase of 71% (1821.97 ± 460.41€ vs. 1066.20 ± 284.34€ p < 0.001). The reduction of one day of stay is equivalent to a reduction of total in-hospital costs of 12.5%. Patients in the IDSS cohort had no significant differences regarding PLIF cohort in the 90-day readmission rate (12.9% vs 11.1% € p > 0.999, respectively), 90-day re-operation rate (12.9% vs 11.1% € p > 0.999) and 90-day complication rates (35.5% vs 52.8% € p > 0.156). Dural tear and urinary tract infection rates were higher in the PLIF cohort (13.9% vs 3.2%. p = 0.205 and 11.1% vs 0% p = 0.118, respectively). Implant related complications were the most frequent in both IDSS and PLIF groups (32.3% vs 38.9% p = 0.572). CONCLUSIONS Patients who underwent IDSS had a significant decrease of the length of stay and costs in relation to PLIF group. No significant differences were found in 90-day readmission and reintervention rates for both groups. Although differences were not significant, dural tear and urinary tract infection rates were lower in the interspinous group. IDSS or PLIF after discectomy, did not protect against subsequent 90-day re-operation or readmission compared to discectomy alone.
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Affiliation(s)
- Manuel Segura-Trepichio
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitario del Vinalopó, Alicante, Spain
- Department of Orthopedic Surgery, Vinalopó University Hospital, Elx/ Elche, 03203 Alicante, Spain
| | - David Candela-Zaplana
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitario del Vinalopó, Alicante, Spain
| | - José Manuel Montoza-Nuñez
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitario del Vinalopó, Alicante, Spain
| | - Antonio Martin-Benlloch
- Departamento de Cirugía Ortopédica y Traumatología, Hospital Universitario Dr Pesset, Valencia, Spain
| | - Andreu Nolasco
- Unidad de investigación para el análisis de las desigualdades en salud y la mortalidad FISABIO-UA, Universidad de Alicante, Alicante, Spain
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Lumbar Spinous Process Fixation and Fusion: A Systematic Review and Critical Analysis of an Emerging Spinal Technology. Clin Spine Surg 2017; 30:E1279-E1288. [PMID: 27438402 DOI: 10.1097/bsd.0000000000000411] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
STUDY DESIGN A systematic review. OBJECTIVE The available literature on interspinous rigid fixation/fusion devices (IFD) was systematically reviewed to explore the devices' efficacy and complication profile. SUMMARY OF BACKGROUND DATA The clinical application of new spinal technologies may proceed without well-established evidence, as is the case with IFDs. IFDs are plate-like devices that are attached to the lateral aspects of 2 adjacent spinous processes to promote rigidity at that segment. Despite almost a decade since the devices' introduction, the literature regarding efficacy and safety is sparse. Complications have been reported but no definitive study is known to the authors. METHODS A systematic review of the past 10 years of English literature was conducted according to PRISMA guidelines. The timeframe was chosen based on publication of the first study containing a modern IFD, the SPIRE, in 2006. All PubMed publications containing MeSH headings or with title or abstract containing any combination of the words "interspinous," "spinous process," "fusion," "fixation," "plate," or "plating" were included. Exclusion criteria consisted of dynamic stabilization devices (X-Stop, DIAM, etc.), cervical spine, pediatrics, and animal models. The articles were blinded to author and journal, assigned a level of evidence by Oxford Centre of Evidence-Based Medicine (OCEBM) criteria, and summarized in an evidentiary table. RESULTS A total of 293 articles were found in the initial search, of which 15 remained after examination for exclusion criteria. No class I or class II evidence regarding IFDs was found. IFDs have been shown by methodologically flawed and highly biased class III evidence to reduce instability at 1 year, without statistical comparison of complication rates against other treatment modalities. CONCLUSIONS Although IFDs are heavily marketed and commonly applied in modern practice, data on safety and efficacy are inadequate. The paucity of evidence warrants reexamination of these devices' value and indications by the spine surgery community.
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Choma TJ, Mroz TE, Goldstein CL, Arnold P, Shamji MF. Emerging Techniques in Degenerative Thoracolumbar Surgery. Neurosurgery 2017; 80:S55-S60. [PMID: 28350946 DOI: 10.1093/neuros/nyw079] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 11/21/2016] [Indexed: 11/15/2022] Open
Abstract
There continue to be incremental advances in thoracolumbar spine surgery techniques in attempts to achieve more predictable outcomes, minimize risk of complications, speed recovery, and minimize the costs of these interventions. This paper reviews recent literature with regard to emerging techniques of interest in the surgical treatment of lumbar spinal stenosis, fusion fixation and graft material, degenerative lumbar spondylolisthesis, and thoracolumbar deformity and sacroiliac joint degeneration. There continue to be advances in minimal access options in these areas, although robust outcome data are heterogeneous in its support. The evidence in support of sacroiliac fusion appears to be growing more robust in the properly selected patient.
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Affiliation(s)
- Theodore J Choma
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Miss-ouri
| | - Thomas E Mroz
- Departments of Orthopaedic and Neurological Surgery, Cleveland Clinic, Cleveland, Ohio
| | | | - Paul Arnold
- Department of Neuro-surgery, University of Kansas, Kansas City, Kansas
| | - Mohammed F Shamji
- Department of Surgery, Uni-versity of Toronto, Toronto, Canada.,Divi-sion of Neurosurgery, Toronto Western Hospital, Toronto, Canada
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Yoshihara H. Indirect decompression in spinal surgery. J Clin Neurosci 2017; 44:63-68. [DOI: 10.1016/j.jocn.2017.06.061] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 06/18/2017] [Indexed: 10/19/2022]
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Nicholson JA, Scott CEH, Duckworth AD, Burke JG, Gibson JNA. Survival analysis of the Wallis interspinous spacer used as an augment to lumbar decompression. Br J Neurosurg 2017; 31:688-694. [PMID: 28691531 DOI: 10.1080/02688697.2017.1351522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECT The Wallis fixed interspinous spacer may augment traditional decompression in the treatment of lumbar spinal stenosis. The aim of this study was to determine factors influencing survival of the Wallis interspinous spacer and to identify specific modes and predictors of failure. METHODS We performed a retrospective cohort study of 244 Wallis interspinous spacers implanted in 195 consecutive patients with a mean age of 56 years (range 21-87) to augment single or multi-level decompression. We examined patient demographics, indications for surgery, surgical techniques and pathology on magnetic resonance imaging (MRI). A Kaplan-Meier survival analysis was performed. RESULTS Median follow-up was 4.5 years (range 2-8). Sixteen patients were lost to follow-up. Repeat MRI was performed in 98 patients (50%). A recurrent stenosis was found in 21% of patients (41/195) and occurred at a similar incidence at the level of the spacer and at adjacent spinal levels. Revision decompression was performed in 19 patients (10%) at 2.8 ± 1.8 years (range 6 months-6 years) with implant removal in 15 and conversion to fusion in 4 patients. No specific patient factors or pre-operative MRI findings predicted failure. Five-year survival was 91% (95% CI: 79-96%). CONCLUSIONS The Wallis implant is generally implanted without complication when used as an adjunct to decompression with a good medium term survival. Though disc heights were maintained, the Wallis spacer did not however appear to reduce the incidence of recurrent spinal or foraminal stenosis from that expected from decompression alone.
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Affiliation(s)
- Jamie A Nicholson
- a Department of Orthopaedics , The Royal Infirmary, University of Edinburgh , Edinburgh , UK
| | - Chloe E H Scott
- a Department of Orthopaedics , The Royal Infirmary, University of Edinburgh , Edinburgh , UK
| | - Andrew D Duckworth
- a Department of Orthopaedics , The Royal Infirmary, University of Edinburgh , Edinburgh , UK
| | - John G Burke
- a Department of Orthopaedics , The Royal Infirmary, University of Edinburgh , Edinburgh , UK
| | - John N Alastair Gibson
- a Department of Orthopaedics , The Royal Infirmary, University of Edinburgh , Edinburgh , UK
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Pintauro M, Duffy A, Vahedi P, Rymarczuk G, Heller J. Interspinous implants: are the new implants better than the last generation? A review. Curr Rev Musculoskelet Med 2017; 10:189-198. [PMID: 28332140 PMCID: PMC5435632 DOI: 10.1007/s12178-017-9401-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW Interspinous process devices (IPDs) are used in the surgical treatment of lumbar spinal stenosis. The purpose of this review is to compare the first generation with the next-generation devices in terms of complications, device failure, reoperation rates, symptom relief, and outcome. RECENT FINDINGS Thirty-seven studies were included from 2011 to 2016. Device failure occurred at a mean of 3.7%, with a lower tendency to happen with next-generation IPDs. Reoperations occurred at a lower rate with the next-generation devices, with a mean follow up of 24 months (3.7% vs. 11.1%). The clinical outcome is not influenced by the type of IPD. The long-term functionality of these devices is questionable, with radiologic changes and recurrence of symptoms often seen by 2 years following implantation. Next-generation devices do not appear to be subject to the same "bounce back" effect of symptom re-emergence after several years.
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Affiliation(s)
- Michael Pintauro
- Department of Neurological Surgery, Thomas Jefferson University, 909 Walnut St, 3rd Floor, COB Bldg, Philadelphia, PA, 19107, USA
| | - Alexander Duffy
- Department of Neurological Surgery, Thomas Jefferson University, 909 Walnut St, 3rd Floor, COB Bldg, Philadelphia, PA, 19107, USA
| | - Payman Vahedi
- Department of Neurological Surgery, Thomas Jefferson University, 909 Walnut St, 3rd Floor, COB Bldg, Philadelphia, PA, 19107, USA.
- Department of Neurosurgery, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran.
| | - George Rymarczuk
- Department of Neurological Surgery, Thomas Jefferson University, 909 Walnut St, 3rd Floor, COB Bldg, Philadelphia, PA, 19107, USA
- Division of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Joshua Heller
- Department of Neurological Surgery, Thomas Jefferson University, 909 Walnut St, 3rd Floor, COB Bldg, Philadelphia, PA, 19107, USA
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Nunley PD, Patel VV, Orndorff DG, Lavelle WF, Block JE, Geisler FH. Superion Interspinous Spacer Treatment of Moderate Spinal Stenosis: 4-Year Results. World Neurosurg 2017; 104:279-283. [PMID: 28479526 DOI: 10.1016/j.wneu.2017.04.163] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 04/25/2017] [Accepted: 04/26/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine 4-year clinical outcomes in patients with moderate lumbar spinal stenosis treated with minimally invasive stand-alone interspinous process decompression using the Superion device. METHODS The 4-year Superion data were extracted from a randomized, controlled Food and Drug Administration investigational device exemption trial. Patients with intermittent neurogenic claudication relieved with back flexion who failed at least 6 months of nonsurgical management were enrolled. Outcomes included Zurich Claudication Questionnaire (ZCQ) symptom severity (ss), physical function (pf) and patient satisfaction (ps) subdomains, leg and back pain visual analog scale (VAS), and Oswestry Disability Index (ODI). At 4-year follow-up, 89 of the 122 patients (73%) provided complete clinical outcome evaluations. RESULTS At 4 years after index procedure, 75 of 89 patients with Superion (84.3%) demonstrated clinical success on at least 2 of 3 ZCQ domains. Individual component responder rates were 83% (74/89), 79% (70/89), and 87% (77/89) for ZCQss, ZCQpf, and ZCQps; 78% (67/86) and 66% (57/86) for leg and back pain VAS; and 62% (55/89) for ODI. Patients with Superion also demonstrated percentage improvements over baseline of 41%, 40%, 73%, 69%, and 61% for ZCQss, ZCQpf, leg pain VAS, back pain VAS, and ODI. Within-group effect sizes all were classified as very large (>1.0): 1.49, 1.65, 1.42, 1.12, and 1.46 for ZCQss, ZCQpf, leg pain VAS, back pain VAS, and ODI. CONCLUSIONS Minimally invasive implantation of the Superion device provides long-term, durable relief of symptoms of intermittent neurogenic claudication for patients with moderate lumbar spinal stenosis.
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Affiliation(s)
| | - Vikas V Patel
- The Spine Center, University of Colorado Hospital, Denver, Colorado, USA
| | | | | | - Jon E Block
- Private practice, San Francisco, California, USA.
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Covaro A, Vilà-Canet G, de Frutos AG, Ubierna MT, Ciccolo F, Caceres E. Management of degenerative lumbar spinal stenosis: an evidence-based review. EFORT Open Rev 2017; 1:267-274. [PMID: 28461958 PMCID: PMC5367584 DOI: 10.1302/2058-5241.1.000030] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Lumbar spinal stenosis has become one of the most disabling pathologies in the elderly population.Some additional conditions such as foraminal stenosis or degenerative spondylosis with a history of back pain and leg pain must be considered before treatment.A completely appropriate protocol and unified management of spinal stenosis have not yet been well defined.The objective of this literature review is to provide evidence-based recommendations reflected in the highest-quality clinical literature available to address key clinical questions surrounding the management of degenerative lumbar spinal stenosis. Cite this article: Covaro A, Vilà-Canet G, García de Frutos A, Ubierna MT, Ciccolo F, Caceres E. Management of degenerative lumbar spinal stenosis: an evidence-based review article. EFORT Open Rev 2016;1:267-274. DOI: 10.1302/2058-5241.1.000030.
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Affiliation(s)
- Augusto Covaro
- ICATME, Institut Universitari Quirón-Dexeus, Barcelona, Spain
| | | | | | - Maite T Ubierna
- ICATME, Institut Universitari Quirón-Dexeus, Barcelona, Spain
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Crawford RJ, Malone QJ, Price RI. Change of sagittal spinal alignment and its association with pain and function after lumbar surgery augmented with an interspinous implant. SCOLIOSIS AND SPINAL DISORDERS 2017; 12:2. [PMID: 28164163 PMCID: PMC5282731 DOI: 10.1186/s13013-017-0109-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 01/17/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Interspinous spacer/implants like the Device for Intervertebral Assisted Motion (DIAM™) are controversially yet commonly used in the surgical treatment of lumbar degenerative pathologies. Criticism is based on ill-defined indications, lack of superiority over decompression, and a poorly understood mechanical effect. Yet, continued use by surgeons implies their perceived clinical merit. We examined radiographic spinal alignment for 12 months, and pain and function for 24 months, after DIAM-augmented surgery to improve the understanding of the mechanical effect relating to clinical outcomes in patients. METHODS We undertook a single-surgeon prospective, longitudinal study of 40 patients (20 F, 20 M) who received DIAM-augmented surgery in treatment of their symptomatic lumbar degenerative condition. Outcomes measured included sagittal spinal alignment (lumbar lordosis, sacral inclination, primary (PDA), supradjacent (SDA) disc angles, and regional sagittal balance (RSB; standing lateral radiographs), and back and leg pain (visual analogue scale; VAS) and function (Oswestry Disability Index; ODI). Responders were identified as those with clinically meaningful improvement to pain (>20%) and function (>15%) at 24 months postoperatively; features of sagittal spinal alignment between responders and non-responders were examined. RESULTS Sagittal alignment was unchanged at 12 months. At 6 weeks postoperatively, PDA (mean (SD)) reduced by 2.2° (4.0°; p < 0.01) and more-so in back pain non-responders (3.8° (3.2°)) than responders (0.7° (4.4°); p < 0.05). Positive preoperative RSB in responders (26.7Rmm (42.3Rmm); Rmm is a system-relative measure) decreased at 6 weeks (by 3.1Rmm (9.1Rmm)). Non-responders had a negative RSB preoperatively (-1.0Rmm (32.0Rmm)) and increased at 6 weeks (11.2Rmm (15.5Rmm); p < 0.05). Clinically meaningful improvement for the whole cohort for back pain and function were observed to 24 months (back pain: 25.0% (28.0); function: 15.4% (17.6); both p < 0.0001). CONCLUSIONS Unaltered sagittal alignment at 12 months was not related to symptoms after DIAM-augmented lumbar surgery. Subtle early flattening at the index disc angle was not maintained. Preoperative and early post-operative sagittal alignment may indicate response after DIAM-augmented surgery for mixed lumbar pathologies. Further investigation toward defining indications and patient suitability is warranted.
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Affiliation(s)
- Rebecca J Crawford
- Institute for Health Sciences, School of Health Professions, Zürich University of Applied Sciences, Technikumstrasse 81, Winterthur, CH-8401 Switzerland.,Faculty of Health and Exercise Sciences, Curtin University, Perth, Australia
| | | | - Roger I Price
- Department of Medical Technology and Physics, Sir Charles Gairdner Hospital, Perth, Australia.,School of Physics, University of Western Australia, Perth, Australia
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Delgado-López PD, Rodríguez-Salazar A, Martín-Alonso J, Martín-Velasco V. [Lumbar disc herniation: Natural history, role of physical examination, timing of surgery, treatment options and conflicts of interests]. Neurocirugia (Astur) 2017; 28:124-134. [PMID: 28130015 DOI: 10.1016/j.neucir.2016.11.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 09/26/2016] [Accepted: 11/24/2016] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Indication for surgery in lumbar disc herniation (LDH) varies widely depending on the geographical area. DEVELOPMENT A literature review is presented on the natural history, role of physical examination, timing of surgery, evidence-based treatment, and conflicts of interests in LDH. Surgery is shown to provide significant faster relief of pain compared to conservative therapy, although the effect fades after a year. There is no treatment modality better than the rest in terms of pain control and neurological recovery, nor is there a surgical technique clearly superior to simple discectomy. The lack of sound scientific evidence on the surgical indication may contribute to its great geographical variability. CONCLUSIONS Since LDH has a favourable natural history, neuroimaging and surgery should not be considered until after a 6-week period. It is necessary to specify and respect the surgical indications for LDH, avoiding conflicts of interests.
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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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Comment on “Controversies about Interspinous Process Devices in the Treatment of Degenerative Lumbar Spine Diseases: Past, Present, and Future”. BIOMED RESEARCH INTERNATIONAL 2017; 2017:6545361. [PMID: 28584819 PMCID: PMC5444032 DOI: 10.1155/2017/6545361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 02/20/2017] [Indexed: 11/17/2022]
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Machado GC, Ferreira PH, Yoo RIJ, Harris IA, Pinheiro MB, Koes BW, van Tulder MW, Rzewuska M, Maher CG, Ferreira ML. Surgical options for lumbar spinal stenosis. Cochrane Database Syst Rev 2016; 11:CD012421. [PMID: 27801521 PMCID: PMC6464992 DOI: 10.1002/14651858.cd012421] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Hospital charges for lumbar spinal stenosis have increased significantly worldwide in recent times, with great variation in the costs and rates of different surgical procedures. There have also been significant increases in the rate of complex fusion and the use of spinal spacer implants compared to that of traditional decompression surgery, even though the former is known to incur costs up to three times higher. Moreover, the superiority of these new surgical procedures over traditional decompression surgery is still unclear. OBJECTIVES To determine the efficacy of surgery in the management of patients with symptomatic lumbar spinal stenosis and the comparative effectiveness between commonly performed surgical techniques to treat this condition on patient-related outcomes. We also aimed to investigate the safety of these surgical interventions by including perioperative surgical data and reoperation rates. SEARCH METHODS Review authors performed electronic searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, AMED, Web of Science, LILACS and three trials registries from their inception to 16 June 2016. Authors also conducted citation tracking on the reference lists of included trials and relevant systematic reviews. SELECTION CRITERIA This review included only randomised controlled trials that investigated the efficacy and safety of surgery compared with no treatment, placebo or sham surgery, or with another surgical technique in patients with lumbar spinal stenosis. DATA COLLECTION AND ANALYSIS Two reviewers independently assessed the studies for inclusion and performed the 'Risk of bias' assessment, using the Cochrane Back and Neck Review Group criteria. Reviewers also extracted demographics, surgery details, and types of outcomes to describe the characteristics of included studies. Primary outcomes were pain intensity, physical function or disability status, quality of life, and recovery. The secondary outcomes included measurements related to surgery, such as perioperative blood loss, operation time, length of hospital stay, reoperation rates, and costs. We grouped trials according to the types of surgical interventions being compared and categorised follow-up times as short-term when less than 12 months and long-term when 12 months or more. Pain and disability scores were converted to a common 0 to 100 scale. We calculated mean differences for continuous outcomes and relative risks for dichotomous outcomes. We pooled data using the random-effects model in Review Manager 5.3, and used the GRADE approach to assess the quality of the evidence. MAIN RESULTS We included a total of 24 randomised controlled trials (reported in 39 published research articles or abstracts) in this review. The trials included 2352 participants with lumbar spinal stenosis with symptoms of neurogenic claudication. None of the included trials compared surgery with no treatment, placebo or sham surgery. Therefore, all included studies compared two or more surgical techniques. We judged all trials to be at high risk of bias for the blinding of care provider domain, and most of the trials failed to adequately conceal the randomisation process, blind the participants or use intention-to-treat analysis. Five trials compared the effects of fusion in addition to decompression surgery. Our results showed no significant differences in pain relief at long-term (mean difference (MD) -0.29, 95% confidence interval (CI) -7.32 to 6.74). Similarly, we found no between-group differences in disability reduction in the long-term (MD 3.26, 95% CI -6.12 to 12.63). Participants who received decompression alone had significantly less perioperative blood loss (MD -0.52 L, 95% CI -0.70 L to -0.34 L) and required shorter operations (MD -107.94 minutes, 95% CI -161.65 minutes to -54.23 minutes) compared with those treated with decompression plus fusion, though we found no difference in the number of reoperations (risk ratio (RR) 1.25, 95% CI 0.81 to 1.92). Another three trials investigated the effects of interspinous process spacer devices compared with conventional bony decompression. These spacer devices resulted in similar reductions in pain (MD -0.55, 95% CI -8.08 to 6.99) and disability (MD 1.25, 95% CI -4.48 to 6.98). The spacer devices required longer operation time (MD 39.11 minutes, 95% CI 19.43 minutes to 58.78 minutes) and were associated with higher risk of reoperation (RR 3.95, 95% CI 2.12 to 7.37), but we found no difference in perioperative blood loss (MD 144.00 mL, 95% CI -209.74 mL to 497.74 mL). Two trials compared interspinous spacer devices with decompression plus fusion. Although we found no difference in pain relief (MD 5.35, 95% CI -1.18 to 11.88), the spacer devices revealed a small but significant effect in disability reduction (MD 5.72, 95% CI 1.28 to 10.15). They were also superior to decompression plus fusion in terms of operation time (MD 78.91 minutes, 95% CI 30.16 minutes to 127.65 minutes) and perioperative blood loss (MD 238.90 mL, 95% CI 182.66 mL to 295.14 mL), however, there was no difference in rate of reoperation (RR 0.70, 95% CI 0.32 to 1.51). Overall there were no differences for the primary or secondary outcomes when different types of surgical decompression techniques were compared among each other. The quality of evidence varied from 'very low quality' to 'high quality'. AUTHORS' CONCLUSIONS The results of this Cochrane review show a paucity of evidence on the efficacy of surgery for lumbar spinal stenosis, as to date no trials have compared surgery with no treatment, placebo or sham surgery. Placebo-controlled trials in surgery are feasible and needed in the field of lumbar spinal stenosis. Our results demonstrate that at present, decompression plus fusion and interspinous process spacers have not been shown to be superior to conventional decompression alone. More methodologically rigorous studies are needed in this field to confirm our results.
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Affiliation(s)
- Gustavo C Machado
- Sydney Medical School, The University of SydneyThe George Institute for Global HealthPO Box M201SydneyAustraliaNSW 2050
| | - Paulo H Ferreira
- The University of SydneyDiscipline of Physiotherapy, Faculty of Health Sciences75 East StreetSydneyLidcombe NSWAustralia1825
| | - Rafael IJ Yoo
- Sydney Medical School, The University of SydneyThe George Institute for Global HealthPO Box M201SydneyAustraliaNSW 2050
| | - Ian A Harris
- South Western Sydney Clinical School, UNSW AustraliaIngham Institute for Applied Medical ResearchElizabeth StreetLiverpoolNew South WalesAustralia2170
| | - Marina B Pinheiro
- The University of SydneyDiscipline of Physiotherapy, Faculty of Health Sciences75 East StreetSydneyLidcombe NSWAustralia1825
| | - Bart W Koes
- Erasmus Medical CenterDepartment of General PracticePO Box 2040RotterdamNetherlands3000 CA
| | - Maurits W van Tulder
- VU University AmsterdamDepartment of Health Sciences, Faculty of Earth and Life SciencesPO Box 7057Room U454AmsterdamNetherlands1007 MB
| | - Magdalena Rzewuska
- University of São PauloDepartment of Social Medicine, Faculty of MedicineAv. Bandeirantes, 3900 ‐ Monte AlegreRibeirão PretoSão PauloBrazil
| | - Christopher G Maher
- Sydney Medical School, The University of SydneyThe George Institute for Global HealthPO Box M201SydneyAustraliaNSW 2050
| | - Manuela L Ferreira
- Sydney Medical School, The University of SydneyThe George Institute for Global Health & Institute of Bone and Joint Research, The Kolling InstituteSydneyNSWAustralia
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Abdel Ghany W, Amer A, Saeed K, Emara E, Hamad A, Nosseir M, Dawood O, Nada MA. Evaluation of Interspinous Spacer Outcomes in Degenerative Lumbar Canal Stenosis: Clinical Study. World Neurosurg 2016; 95:556-564.e3. [DOI: 10.1016/j.wneu.2016.07.095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 07/26/2016] [Accepted: 07/27/2016] [Indexed: 12/01/2022]
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47
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Risk Factors of Postoperative Low Back Pain for Lumbar Spine Disease. World Neurosurg 2016; 94:248-254. [DOI: 10.1016/j.wneu.2016.07.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 06/30/2016] [Accepted: 07/01/2016] [Indexed: 11/20/2022]
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Viezens L, Dreimann M, Gessler R, Stangenberg M, Eicker SO. Lumbar Neuroforaminal Decompression with a Flexible Microblade Shaver System: Results of a Cadaveric Study. World Neurosurg 2016; 94:57-63. [PMID: 27377224 DOI: 10.1016/j.wneu.2016.06.106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2016] [Revised: 06/22/2016] [Accepted: 06/23/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The lumbar neural foraminal stenosis still is a challenging condition in minimally invasive spine surgery. Because of the anatomic situation a complete decompression of the nerve root often leads to a subtotal facetectomy associated with potential instability and the need for additional instrumentation of the decompressed segment. The iO-Flex system was introduced to address this problem by using a minimally invasive wire-guided microblade shaver to increase the neuroforaminal space by reducing the stenosis from intraforaminal while sparing bigger parts of the facet joint. In this study, we evaluated the feasibility and the surgical and radiological success in relation to the experience of the surgeon. METHODS We performed decompression of the neuroforamen in 10 lumbar levels of 2 fresh-frozen human cadavers. Before and after decompression, we obtained high-resolution computed tomography data to evaluate the diameter of the neural foramen. RESULTS The mean foraminal width (7.88-10.94 mm, P < 0.0001) and area (123.27-149.18 mm2, P < 0.003) increased significantly after the decompression, whereas the facet joints area (131.9-107.51 mm2, P < 0.005) and width (16.4-13.75 mm, P < 0.001) indeed decreased significantly but with an overall reduction of facet joint width by 16% and facet joint area by 18%. No complications such as nerve root damages or dural tears were observed. CONCLUSIONS The flexible micro blade shaver system is feasible with a steep learning curve and achieves sufficient decompression of the neuroforamen in this cadaveric study.
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Affiliation(s)
- Lennart Viezens
- Department of Trauma-, Orthopaedic and Reconstructive Surgery, University Medical Center Goettingen, Goettingen, Germany; Department of Trauma, Hand and Reconstructive Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
| | - Marc Dreimann
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Roland Gessler
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Stangenberg
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Sven Oliver Eicker
- Department of Neurosurgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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Mikula AL, Williams SK, Anderson PA. The use of intraoperative triggered electromyography to detect misplaced pedicle screws: a systematic review and meta-analysis. J Neurosurg Spine 2016; 24:624-38. [DOI: 10.3171/2015.6.spine141323] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
Insertion of instruments or implants into the spine carries a risk for injury to neural tissue. Triggered electromyography (tEMG) is an intraoperative neuromonitoring technique that involves electrical stimulation of a tool or screw and subsequent measurement of muscle action potentials from myotomes innervated by nerve roots near the stimulated instrument. The authors of this study sought to determine the ability of tEMG to detect misplaced pedicle screws (PSs).
METHODS
The authors searched the US National Library of Medicine, the Web of Science Core Collection database, and the Cochrane Central Register of Controlled Trials for PS studies. A meta-analysis of these studies was performed on a per-screw basis to determine the ability of tEMG to detect misplaced PSs. Sensitivity, specificity, and receiver operating characteristic (ROC) area under the curve (AUC) were calculated overall and in subgroups.
RESULTS
Twenty-six studies were included in the systematic review. The authors analyzed 18 studies in which tEMG was used during PS placement in the meta-analysis, representing data from 2932 patients and 15,065 screws. The overall sensitivity of tEMG for detecting misplaced PSs was 0.78, and the specificity was 0.94. The overall ROC AUC was 0.96. A tEMG current threshold of 10–12 mA (ROC AUC 0.99) and a pulse duration of 300 µsec (ROC AUC 0.97) provided the most accurate testing parameters for detecting misplaced screws. Screws most accurately conducted EMG signals (ROC AUC 0.98).
CONCLUSIONS
Triggered electromyography has very high specificity but only fair sensitivity for detecting malpositioned PSs.
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Affiliation(s)
| | - Seth K. Williams
- 2Department of Orthopedics and Rehabilitation, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Paul A. Anderson
- 2Department of Orthopedics and Rehabilitation, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
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50
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Interspinous spacers versus posterior lumbar interbody fusion for degenerative lumbar spinal diseases: a meta-analysis of prospective studies. INTERNATIONAL ORTHOPAEDICS 2016; 40:1135-42. [PMID: 26907877 DOI: 10.1007/s00264-016-3139-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 02/15/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Our aim is to evaluate the safety and effectiveness of interspinous spacers versus posterior lumbar interbody fusion (PLIF) for degenerative lumbar spinal diseases. METHODS A comprehensive literature search was performed using PubMed, Web of Science and Cochrane Library through September 2015. Included studies were performed according to eligibility criteria. Data of complication rate, post-operative back visual analogue scale (VAS) score, Oswestry Disability Index (ODI) score, estimated blood loss (EBL), operative time, length of hospital stay (LOS), range of motion (ROM) at the surgical, proximal and distal segments were extracted and analyzed. RESULTS Ten studies were selected from 177 citations. The pooled data demonstrated the interspinous spacers group had a lower estimated blood loss (weighted mean difference [WMD]: -175.66 ml; 95 % confidence interval [CI], -241.03 to -110.30; p < 0.00001), shorter operative time (WMD: -55.47 min; 95%CI, -74.29 to -36.65; p < 0.00001), larger range of motion (ROM) at the surgical segment (WMD: 3.97 degree; 95%CI, -3.24 to -1.91; p < 0.00001) and more limited ROM at the proximal segment (WMD: -2.58 degree; 95%CI, 2.48 to 5.47; p < 0.00001) after operation. Post-operative back VAS score, ODI score, length of hospital stay, complication rate and ROM at the distal segment showed no difference between the two groups. CONCLUSIONS Our meta-analysis suggested that interspinous spacers appear to be a safe and effective alternative to PLIF for selective patients with degenerative lumbar spinal diseases. However, more randomized controlled trials (RCT) are still needed to further confirm our results.
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