Adjustable Rigid Interspinous Process Fixation: A Biomechanical Study of Segmental Lordosis and Interbody Loading in the Lumbar Spine

Posterior Midline Interspinal Fixation (PMIF) to Treat Persistent Severe Pain Due to Severe Compression Fracture of Thoracic Vertebral Body: A Case Report

Generally, severe persistent pain due to compression fractures of the lumbar and thoracic vertebral bodies in the elderly, that fail conservative measures are treated with vertebroplasty or kyphoplasty. However, in the case reported in this paper, the compression fracture was so severe, that accurate bone needle placement into the vertebral body was felt to be difficult. In addition, there was a high risk of extravasation of the cement into the surrounding structures or blow-up of the lateral wall of the vertebral body. Therefore, a simple operation of posterior midline interspinal fixation (PMIF) was performed. The patient was a 91-year-old lady with severe pain in the mid-thoracic spine due to a severe compression fracture of the seventh thoracic vertebral body that was totally flattened in its anterior part. The patient was neurologically intact. However, she had difficulty walking, because the pain was very severe in an upright position. She was treated with a back brace and oxycodone for six weeks without any benefit. Because she was a poor candidate for vertebroplasty or kyphoplasty, a PMIF system was implanted. Postoperatively, within two weeks, her pain score dropped from 9/10 to 0/10; and from two months onwards she was completely free of pain medications until her death from an unrelated cause, 18 months after the operation. This is the first reported case of PMIF for the treatment of pain due to vertebral body compression fracture in the elderly. PMIF is a simple minimally invasive procedure without compromising the facet or any bony structure. The risk of severe complications, therefore, is remote. The success in this single case, therefore, begs for further exploration of this method in the treatment of compression fractures in the elderly.

Inter Spinal Fixation and Stabilization Device for Lumbar Radiculopathy and Back Pain

Introduction: Generally, interspinal distractor fixation devices are used for severe low back pain associated with neurogenic claudication, and radiculopathy with central or lateral recess stenosis and/or foraminal narrowing. In this paper, the authors result in cases of severe low back pain and lumbar radiculopathy in whom this device was used with excellent results.

Method: This is a retrospective study. Patients were contacted via phone call and their pain score and other data were recorded at different timelines. The final data presented in this paper are the data collected at the final follow-up that ranges from 14 months to 24 months. Surgeries were performed in the outpatient setting and although no identifiable patient information is included in this paper, yet, patients were asked for their verbal consent. The patient data are only included if verbal consent was obtained.

Results: Over the past 24 months, 13 patients with disc protrusion and/or central and/or foraminal spinal stenosis were treated with this procedure. Follow-up ranges from 14 months to 24 months with a median of 19 months, male/female ratio of 6/7, and a median age of 68 years. There were no complications or reoperation. Statistical analysis showed significant improvement in the Numeric Pain Rating Scale (NPRS) for back and radicular leg pain (p-value = 0.000552 for back pain and p-value = 0.000291 for radicular leg pain).

Conclusion: The system reported in this paper is a solid fixation system that works both as a distractor and internal decompressor of the spinal canal. It is simple to use and safe. Though the number of patients is small, statistically significant improvement was reported at a median follow-up of 19 months.