Controversies about Interspinous Process Devices in the Treatment of Degenerative Lumbar Spine Diseases: Past, Present, and Future

Roberto Gazzeri,Marcelo Galarza,Alex Alfieri

doi:10.1155/2014/975052

Abstract

A large number of interspinous process devices (IPD) have been recently introduced to the lumbar spine market as an alternative to conventional decompressive surgery in managing symptomatic lumbar spinal pathology, especially in the older population. Despite the fact that they are composed of a wide range of different materials including titanium, polyetheretherketone, and elastomeric compounds, the aim of these devices is to unload spine, restoring foraminal height, and stabilize the spine by distracting the spinous processes. Although the initial reports represented the IPD as a safe, effective, and minimally invasive surgical alternative for relief of neurological symptoms in patients with low back degenerative diseases, recent studies have demonstrated less impressive clinical results and higher rate of failure than initially reported. The purpose of this paper is to provide a comprehensive overview on interspinous implants, their mechanisms of action, safety, cost, and effectiveness in the treatment of lumbar stenosis and degenerative disc diseases.

Highlights

The degenerative lumbar spine is associated with significant structural failure of the intervertebral disc, of the ligaments, and/or of the bone structures [1]
The purpose of this paper is to provide a comprehensive overview on interspinous implants, their mechanisms of action, safety, cost, and effectiveness in the treatment of lumbar stenosis and degenerative disc diseases
Interspinous devices with shock absorption and postoperative adjustability may present the future of these devices

Summary

Introduction

The degenerative lumbar spine is associated with significant structural failure of the intervertebral disc, of the ligaments, and/or of the bone structures [1]. The typical findings are radial fissures, prolapses, endplate damage, annular protrusion, internal disc disruption, disc space narrowing, hypertrophic ligaments, hypertrophic facet joints, and osteophytes [1,2,3,4]. These degenerative changes may cause instability in advanced stages of the disease [5,6,7,8,9,10,11,12,13,14,15,16,17,18,19]. Some investigators began to explore novel minimally invasive approaches to stabilize the lumbar spine

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