Abstract
PurposeTo evaluate the effect on the spinal canal at the treated and adjacent level(s), in patients treated for lumbar spinal stenosis (LSS) with percutaneous interspinous process device (IPD) Aperius™ or open decompressive surgery (ODS), using axial loading of the spine during MRI (alMRI).MaterialsNineteen LSS patients (mean age 67 years, range 49–78) treated with IPDs in 29 spine levels and 13 LSS patients (mean age 63 years, range 46–76) operated with ODS in 22 spine levels were examined with alMRI pre- and 3 months postoperatively. Radiological effects were evaluated by measuring the dural sac cross-sectional area (DSCSA) and by morphological grading of nerve root affection.ResultsFor the IPD group, no DSCSA increase was observed at the operated level (p = 0.42); however, a decrease was observed in adjacent levels (p = 0.05). No effect was seen regarding morphological grading (operated level: p = 0.71/adjacent level: p = 0.94). For the ODS group, beneficial effects were seen for the operated level, both regarding DSCSA (p < 0.001) and for morphological grading (p < 0.0001). No changes were seen for adjacent levels (DSCSA; p = 0.47/morphological grading: p = 0.95). Postoperatively, a significant difference between the groups existed at the operated level regarding both evaluated parameters (p < 0.003).ConclusionsWith the spine imaged in an axial loaded position, no significant radiological effects of an IPD could be detected postoperatively at the treated level, while increased DSCSA was displayed for the ODS group. In addition, reduced DSCSA in adjacent levels was detected for the IPD group. Thus, the beneficial effects of IPD implants on the spinal canal must be questioned.Graphic abstractThese slides can be retrieved under Electronic Supplementary Material.
Highlights
Degenerative lumbar spinal stenosis (LSS) is becoming more frequently diagnosed due to the aging population and, to some extent, better access to advanced imaging facilities such as magnetic resonance imaging (MRI)
The aim of the current study was to evaluate the effect on the spinal canal at the operated level and in adjacent levels, in patients treated for LSS with an interspinous process device (IPD) in comparison with a group operated with open decompressive surgery (ODS), using axial loading during MRI (alMRI)
Besides from improvements in dural sac cross-sectional area (DSCSA), the ODS group in our study showed a beneficial change in the morphological stenos grade (Table 2), indicating less impingement of the neural tissues after the surgery [20], an effect that was not seen for the patients treated with IPD
Summary
Degenerative lumbar spinal stenosis (LSS) is becoming more frequently diagnosed due to the aging population and, to some extent, better access to advanced imaging facilities such as magnetic resonance imaging (MRI). Due to risks of morbidity and mortality associated with general anesthesia and open surgery methods, especially in the elderly patients with severe or multiple comorbidities, less invasive surgical treatments such as interspinous process devices (IPDs) have been developed [7]. Such IPDs are inserted between the spinal processes of the stenotic level aiming to increase the interlaminar space, the central spinal canal area and the vertebral foramens at the symptomatic level. Such IPDs aim to position the spinal segment treated in a slightly flexed position to relieve the clinical symptoms [8]
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