Surgical treatment of lumbar spinal stenosis with microdecompression and interspinous distraction device insertion. A case series

Journal of Orthopaedic Surgery and Research, Oct 2012

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.

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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 - 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)


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Avraam Ploumis, Pavlos Christodoulou, Dimitrios Kapoutsis, Ioannis Gelalis, Vasilios Vraggalas, Alexander Beris. Surgical treatment of lumbar spinal stenosis with microdecompression and interspinous distraction device insertion. A case series, Journal of Orthopaedic Surgery and Research, 2012, pp. 35, 7, DOI: 10.1186/1749-799X-7-35