16 Oct Élton José Xavier Gomes
Furthermore, the authors claim in the Expert Commentary that “Interspinous spacers fill a distinct treatment gap in the continuum of care for patients with moderate degenerative lumbar spinal stenosis.” The understanding and treatment of LSS has been known for more than 50 years.10 If this gap is so distinct, why hasn’t it been recognized earlier? PLoS One. Average Improvement in Pain Scores, Disability, and Functional Impairment. These procedures involve removing a small part of the bony arches of the spinal canal, called the lamina. The most common level was L4-5 and the most associated radiologic condition was degenerative stenosis with grade 1 spondylolisthesis. Register to receive personalised research and resources by email, Stand-alone interspinous spacer versus decompressive laminectomy for treatment of lumbar spinal stenosis, Neurosurgical Spine Institute, Lakeway, TX 78738, USA, Orange County Neurosurgical Associates, Laguna Hills, CA 92653, USA, Tucson Orthopaedic Institute, Tucson, AZ 85712, USA, Upstate Bone and Joint Center, East Syracuse, NY 13057, USA, Rush University Medical Center, Chicago, IL 60612, USA, Independent Scholar, San Francisco, CA 94115, USA, Chicago Back Institute, Chicago, IL 60625, USA, /doi/full/10.1586/17434440.2015.1100071?needAccess=true. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. 2015;40(2):77-85. Over 24 months a total of 86 patients underwent various surgical treatments of symptomatic neurogenic claudication for lumbar spinal stenosis. Spine (Phila Pa 1976). 7. If left untreated, permanent nerve damage may occur. Patients are encouraged to walk regularly and/or participate in physical therapy following the procedure. This article by Lauryssen et al fully demonstrates a problematic issue concerning interspinous process decompression devices (IPD) in surgical treatment of lumbar spinal stenosis (LSS). Research made independently from the industry has to lead us on the way to better knowledge. This ensures greater security and protects you as a patient. This content does not have an English version. How he or she gets there is of less consequence. This usually happens on one side or the other, but can be done on both sides. These treatments are effective in only a small percentage of patients. The mild procedure is performed under deep sedation through a 1-cm incision. PLoS One. Only 16% of these patients were on anti-coagulant medications that had to be stopped before the procedure (Table 1). Furthermore, studies confirm that fusion is associated with greater complications and postoperative mortality than decompression alone [6-7]. DM and DM with pathologic sequelae are closely associated with postoperative surgical site infection, leading to a worse prognosis. In a cervical laminectomy, the laminae of a cervical vertebra are removed to widen the spinal canal and relieve pressure on the spinal cord and nerves. Both procedures are considered quite safe and effective, but as with any surgery, carry risks for complications, such as bleeding, infection, nerve damage or dural puncture. This site complies with the HONcode standard for trustworthy health information: verify here. They are discharged home after a couple of hours and are able to begin the rehabilitation program. "It is a new and powerful technique that is gaining more favor.". Minimally invasive decompression versus open laminectomy for central stenosis of the lumbar spine: Pragmatic comparative effectiveness study. The mean BMI was 30.31 and five patients, had a BMI of 35 or 38%, compared to the open surgical group where very few patients (less than 10%) had a BMI over 35. The BMJ. It is important to evaluate and compare the volume changes between the bone and ligaments and the dural sac over multiple slices on MRI and CT scans [3]. “Those who have the procedure are able to get back to more normal living and to the activities they enjoy very quickly.”. All rights reserved. 2010;13(1):39-46. Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults, Trends in isolated lumbar spinal stenosis surgery among working US adults aged 40-64 years, 2010-2014, Comparison of multifidus muscle atrophy and trunk extension muscle strength: percutaneous versus open pedicle screw fixation, Minimally invasive versus open laminectomy/discectomy, transforaminal lumbar, and posterior lumbar interbody fusions: a systematic review, Influence of diabetes mellitus on patients with lumbar spinal stenosis: A nationwide population-based study, Risk factors for immediate postoperative complications and mortality following spine surgery: a study of 3475 patients from the national surgical quality improvement program, Interspinous implants to treat spinal stenosis, VertiFlex®, Incorporated: instructions for use SUPERION® Interspinous spacer, https://www.accessdata.fda.gov/cdrh_docs/pdf14/P140004D.pdf, Superion interspinous process spacer for intermittent neurogenic claudication secondary to moderate lumbar spinal stenosis: two-year results from a randomized controlled FDA-IDE pivotal trial, Cost-effectiveness of three treatment strategies for lumbar spinal stenosis: conservative care, laminectomy, and the Superion interspinous spacer, Segmental spinal canal volume in patients with degenerative spondylolisthesis. Dr. Lønne states there is a role for interspinous devices. He says LSS usually affects people in their seventh decade of life. Make a donation. The surgery relieves pressure on compressed nerves. Both include the word lamina – which is the thin bony covering across the back of the vertebrae that protects the spinal cord, nerves and arteries. 11. It is important to consult with a fellowship trained spine specialist about which procedure is appropriate for your spine condition. Pain and functional evaluation include VAS and ODI as well as functional testing such as ZCQ scale and distance walking. Orthopedic Spine Surgeon “Statistical significance was not assessed in this paper since it compares the results from the prospective study on the results of Superion versus historical studies reporting the effectiveness of a lumbar laminectomy,” Dr. Deutsch explained. Harel Deutsch, MD By utilizing sequentially larger tubes, the working channel is expanded without cutting muscle fibers. The authors correctly state in the beginning of the paper that one of the major ramifications of the “…increasing proportion of individuals living to advanced age is the impact and burden on the health care system associated with age-related degeneration of the musculoskeletal system." Why are there different versions of the Oswestry Disability Index? Though now widely used, the indications and limitations of novel techniques in spine surgery are not always well-understood, and until recently, there has been a lack of scientific evidence to support their safety and effectiveness.
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