Abstract
BackgroundDegenerative lumbar spinal stenosis is a condition related to aging in which structural changes cause narrowing of the central canal and intervertebral foramen. It is currently the leading cause for spinal surgery in patients over 65 years. Interspinous process devices (IPDs) were introduced as a less invasive surgical alternative, but questions regarding safety, efficacy, and cost-effectiveness are still unanswered.ObjectivesThe aim of this study was to provide complete and reliable information regarding benefits and harms of IPDs when compared to conservative treatment or decompression surgery and suggest directions for forthcoming RCTs.MethodsWe searched MEDLINE, EMBASE, Cochrane Library, Scopus, and LILACS for randomized and quasi-randomized trials, without language or period restrictions, comparing IPDs to conservative treatment or decompressive surgery in adults with symptomatic degenerative lumbar spine stenosis. Data extraction and analysis were conducted following the Cochrane Handbook. Primary outcomes were pain assessment, functional impairment, Zurich Claudication Questionnaire, and reoperation rates. Secondary outcomes were quality of life, complications, and cost-effectiveness. This systematic review was registered at Prospero (International prospective register of systematic reviews) under number 42015023604.ResultsThe search strategy resulted in 17 potentially eligible reports. At the end, nine reports were included and eight were excluded. Overall quality of evidence was low. One trial compared IPDs to conservative treatment: IPDs presented better pain, functional status, quality of life outcomes, and higher complication risk. Five trials compared IPDs to decompressive surgery: pain, functional status, and quality of life had similar outcomes. IPD implant presented a significantly higher risk of reoperation. We found low-quality evidence that IPDs resulted in similar outcomes when compared to standard decompression surgery. Primary and secondary outcomes were not measured in all studies and were often published in incomplete form. Subgroup analysis was not feasible. Difficulty in contacting authors may have prevented us of including data in quantitative analysis.ConclusionsPatients submitted to IPD implants had significantly higher rates of reoperation, with lower cost-effectiveness. Future trials should improve in design quality and data reporting, with longer follow-up periods.
Highlights
Degenerative lumbar spinal stenosis (DLSS) is a condition related to aging in which changes in facet joints, ligamentum flavum, posterior longitudinal ligament and intervertebral disc cause narrowing of the central canal and intervertebral foramen [1].Central canal narrowing is mostly associated to neurogenic claudication, while lateral recess and intervertebral foramen stenosis usually present with radicular syndromes
Patients submitted to Interspinous process devices (IPDs) implants had significantly higher rates of reoperation, with lower cost-effectiveness
Longer follow-up periods of more than 2 years should be pursued, and subgroup analysis based on age and symptom intensity could better clarify if there is a subpopulation of patients that may benefit from IPDs
Summary
Degenerative lumbar spinal stenosis (DLSS) is a condition related to aging in which changes in facet joints, ligamentum flavum, posterior longitudinal ligament and intervertebral disc cause narrowing of the central canal and intervertebral foramen [1]. Central canal narrowing is mostly associated to neurogenic claudication, while lateral recess and intervertebral foramen stenosis usually present with radicular syndromes. DLSS is currently the leading cause for spinal surgery in patients over 65 years[5]. Degenerative lumbar spinal stenosis is a condition related to aging in which structural changes cause narrowing of the central canal and intervertebral foramen. It is currently the leading cause for spinal surgery in patients over 65 years. Interspinous process devices (IPDs) were introduced as a less invasive surgical alternative, but questions regarding safety, efficacy, and cost-effectiveness are still unanswered
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