Application of Percutaneous Dynamic Interspinous Stabilization in Lumbar Spine in Combination with Percutaneous Intradiscal Laser Nucleotomy

Abstract

Study Design Comparison outcome treatment of pain syndromes in lumbar degenerative disk disease (DDD) in application two combined minimally invasive methods of treatment in intervertebral disk (IVD) herniations. Objectives To estimate and compare the treatment effectiveness of laser IVD vaporization in combination with dynamic stabilization by percutaneous interspinous implant In-Space. Background Data The method of laser vaporization is based on impact of laser radiation on IVD tissue. The impact of laser radiation impulse lead to the creation of vaporization defect of few square millimeter area and reduction of the intradiscal pressure. The reduction of pressure out of disk causing pain syndrome occurs indirectly. The reduction of disk volume and pressure in it can lead to instability in spinal motion segment and redistribution of loads to facet joints, accelerate development of spondyloarthrosis and lead to appearance of facet syndrom. Height reduction in the posterior column of the lumbar spine accelerate spinal canal stenosis. Pain syndrome recurrences more frequently occur in previous laser vaporization signs of segmental instability. Materials and Methods There were selected patients who were operated (71 females and 55 males) at the age of 28 to 46 with protrusions of IVD and presence of signs of spondyloarthrosis. There were two groups of patients: the first group consisted of 109 patients and underwent laser vaporization of IVD by laser Nd-YAG Dornier; the second group consisted of 17 patients with laser vaporization in combination with percutaneous interspinous stabilization by In-Space (Synthes) implant. In the first group, pathology located on the levels L3-L4 (18 cases), L4-L5 (52 cases) and L5-S1 (39 cases), in the second group on the levels L3-L4 (3 cases), L4-L5 (10 cases), and L5-S1 (4 cases). Relatively less quantity of patients with the level L5-S1 in the second group is caused by selection and limited opportunities of interspinous fixation on this level owing to anatomical peculiarity. Laser vaporization operation of IVD was performed under local anesthesia in the standard regime and takes 25 minutes in the average. The second stage in the second group to the interspinous space from lateral puncture was inserted interspinal stabilizer with 15 minutes duration under local or intravenous anesthesia. All manipulations were performed under X-ray control. Results As a result of treatment, it is managed to gain significant improvement quality of patients life estimated by ODI (23%, from 9.5 to 31%) in discharge for all patients. The results of treatment showed the outcomes as follows: in first group outcomes according to Mac Nab scale areexcellent 59 (54.1%) patients, good 42 (38.5%), satisfactory 8 (7.37%). According to Nurick scale, excellent 61 (64.3%) patients, improvement 19 (17.4%), without dynamic 17 (15.6%), worsening 3 (2.7%). Three patients in the postoperative follow-up had herniation recurrence. In the second group, outcomes according to Mac Nab are as follows: excellent 14 (82.3%), good 3 (17.7%). According to Nurick, excellent 12 (70.5%), improvement 5 (29.5%). Discussion The application of percutaneous dynamic interspinous stabilization in combination with laser vaporization of IVD allowed to improve treatment results of patients with lumbar DDD pain syndrome. The combination of these methods allow to decrease intradiscal pressure, to gain long-term deception of disk, reduction of disk protrusion, and to prevent or eliminate development of segmental instability. The installed implant extend interspinous space, perform expanding of ligaments and restoring foraminal height, reloading of facet joints and occurs restoration of congruence its articulation surfaces. Thus, it is restores natural topographic and anatomic relations in the spinal motion segment by saving its mobility which is confirmed by follow-up X-ray films and clinically neurological results in the long-term follow-up. Conclusion Performing percutaneous dynamic interspinous stabilization after laser vaporization of IVD is an effective method of treatment of pain syndrome in comparison with isolated application of laser vaporization. I confirm having declared any potential conflict of interest for all authors listed on this abstract Yes Disclosure of Interest None declared