Surgical treatment of lumbar spinal stenosis with microdecompression and interspinous distraction device insertion. A case series
Journal of Orthopaedic Surgery and Research
Surgical treatment of lumbar spinal stenosis with microdecompression and interspinous distraction device insertion. A case series
Avraam Ploumis 0 1
Pavlos Christodoulou 0
Dimitrios Kapoutsis 0
Ioannis Gelalis 1
Vasilios Vraggalas 0
Alexander Beris 1
0 Orthopaedic Department, 424 General Army Hospital , Thessaloniki , Greece
1 Departments of Orthopaedics and Rehabilitation, University of Ioannina , Ioannina , Greece
Background: Interspinous distraction devices (IPDD) are indicated as stand-alone devices for the treatment of spinal stenosis. The purpose of this study is to evaluate the results of patients undergoing surgery for spinal stenosis with a combination of unilateral microdecompression and interspinous distraction device insertion. Methods: This is a prospective clinical and radiological study of minimum 2 years follow-up. Twenty-two patients (average age 64.5 years) with low-back pain and unilateral sciatica underwent decompressive surgery for lumbar spinal stenosis. Visual Analogue Scale, Oswestry Disability Index and walking capacity plus radiologic measurements of posterior disc height of the involved level and lumbar lordosis Cobb angle were documented both preoperatively and postoperatively. One-sided posterior subarticular and foraminal decompression was conducted followed by dynamic stabilization of the diseased level with an IPDD (X-STOP). Results: The average follow-up time was 27.4 months. Visual Analogue Scale and Oswestry Disability Index improved statistically significantly (p < 0.001) in the last follow-up exam. Also, the walking distance increased in all patients but two. Posterior intervertebral disc height of the diseased level widened average 1.8 mm in the postoperative radiograph compared to the preoperative. No major complication, including implant failure or spinous process breakage, has been observed. Conclusions: The described surgical technique using unilateral microdecompression and IPDD insertion is a clinically effective and radiologically viable treatment method for symptoms of spinal stenosis resistant to non-operative treatment.
IPDD; X-STOP; Microdecompression; Spinal stenosis
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Background
Lumbar spinal stenosis, refractory to nonoperative
treatment, has been traditionally treated with surgical
decompression achieving good and excellent results in
almost 80% of the cases [1]. In case of coexisting instability
or deformity or discogenic pain, fusion is added. However,
the immobilization of a spinal unit causes significant
functional changes to the patients in terms of spinal
mobility and symptomatology originating from adjacent
segments [2].
Dynamic stabilization spinal system is defined as the
system that alters favorably the biomechanics
(movement and load transmission) of a spinal motion segment,
without immobilization of the segment [3,4]. X-STOP is
an interspinous distraction device (IPDD) leading to
indirect decompression by distraction [5] and disc
unloading [6]. It is indicated for patients older than 50 years
old with symptomatology of neurogenic claudication and
radiographic spinal stenosis up to two levels. It has been
suggested to be superior to laminectomy with or without
fusion for the above indications offering minimal surgical
trauma, avoidance of bone removal, immediate symptom
relief, fast recovery and rehabilitation and low complication
rate [7-9].
This is the first usage of X-STOP (by St. Francis
Medical Technologies, Inc. Alameda, CA and, lately,
by Medtronic Inc., Minneapolis, MN) device, an FDA
approved IPDD for patients with spinal stenosis [10],
in conjunction with minimally invasive lateral
decompression [11]. The purpose of this study is to present
the two-year follow-up results of surgical treatment for
patients with symptomatology of low-back pain and
unilateral sciatica due to spinal stenosis who did not
respond to nonoperative treatment. Our hypothesis is
that the combination of mini-open lateral decompression
and X-STOP insertion causes clinical improvement of
symptomatology without lordosis deterioration. Since no
control group was used, this mode of treatment is
compared to outcomes reported in studies using X-STOP
alone for lumbar spinal stenosis.
Methods
This a prospective study of 22 patients aged between
5771 years (average 64.5 years) with unilateral sciatica
and low-back pain, in the form of neurogenic intermittent
claudication, who were treated by unilateral
microdecompression and X-STOP insertion in our hospital between
20062007. All patients consented to participate in the
study and ethics committee approval (no 11/2005 424
General Army Hospital, Thessaloniki, Greece) for the study
was obtained. The average T-score of bone density
measurement (DEXA) studies of the aforementioned patients
was 1.9. Patients activities involved mainly household
duties, gardening and daily walking but the disease
significantly affected their quality of life. All patients had plain
x-rays in stand (...truncated)