Interspinous Process Decompression Improves Quality of Life in Patients with Lumbar Spinal Stenosis.

Pierce D Nunley,Fred H Geisler,Jon E Block,Douglas G Orndorff,William F Lavelle,Vikas V Patel

doi:10.1155/2018/1035954

Abstract

Lumbar spinal stenosis has been shown to negatively impact health-related quality of life. Interspinous process decompression (IPD) is a minimally invasive procedure that utilizes a stand-alone spacer to serve as a joint extension blocker to relieve neural compression in patients with spinal stenosis. Using the 5-year results from an FDA randomized controlled trial of IPD, the quality of life in 189 patients treated with the Superion® spacer was evaluated with the SF-12. Physical and mental component summary (PCS, MCS) scores were computed preoperatively and at annual intervals. For the PCS, mean scores improved from 29.4 ± 8.1 preoperatively to 41.2 ± 12.4 at 2 years (40%) and to 43.8 ± 11.6 at 5 years (49%) (p<0.001 for both comparisons). At 2 years, 81% (103 of 128) of subjects demonstrated maintenance or improvement in PCS scores. The mean MCS score improved from 50.0 ± 12.7 preoperatively to 54.4 ± 10.6 and 54.7 ± 8.6 at 2 and 5 years, respectively (p>0.10 for both comparisons). These results demonstrate that the significant impairment in physical well-being found in patients with lumbar spinal stenosis can be ameliorated, in large part, by IPD treatment.

Highlights

The classic clinical feature of lumbar spinal stenosis is neurogenic claudication which causes intermittent lower extremity pain and diminished functional abilities [1]
This multicenter trial evaluated the use of stand-alone Interspinous process decompression (IPD) in the treatment of subjects aged 45 or older with moderate symptoms of intermittent neurogenic claudication, secondary to a diagnosis of moderate degenerative lumbar spinal stenosis at one or two contiguous levels from L1 to L5
The mean physical component summary (PCS) score improved from 29.4 ± 8.1 preoperatively to 41.2 ± 12.4 at the 2-year primary trial endpoint and to 43.8 ± 11.6 at 5 years, representing average percentage improvements of 40% and 49%, respectively (p

Summary

Introduction

The classic clinical feature of lumbar spinal stenosis is neurogenic claudication which causes intermittent lower extremity pain and diminished functional abilities [1]. Interspinous process decompression (IPD) devices (aka “spacers”) were developed to address a distinct therapeutic gap in the continuum of care of lumbar spinal stenosis treatment [3]. Interspinous spacers effectively bridge the often lengthy interval between failed conservative care and the point where surgical decompression becomes necessary to manage intractable symptoms. These devices are inserted posteriorly via a minimally invasive procedure without disruption of osseous or ligamentous tissues. Spacers provide immediate symptom amelioration by serving as a spinal extension blocker to prevent the repetitive compression of neural elements during back extension that is the primary source of claudicant symptoms

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Results

Conclusion