Abstract
PurposeThe purpose of this study is to report clinical outcome and imaging changes of percutaneous Aperius stand-alone implant in patients with degenerative lumbar spinal stenosis and neurogenic intermittent claudication, which did not respond to conservative treatment.MethodBetween January 2008 and July 2010, 37 patients (20 males and 17 females) with mean age of 64.3 years underwent surgery for the onset of claudicatio spinalis with Aperius PercLID interspinous device (Medtronic). In all patients, the diagnosis was: foraminal stenosis, in one case (2.7 %) it was associated to a degenerative anterior listhesis (I grade), in three cases (8.1 %) it was associated to an intraforaminal disc herniation. The mean follow-up was of 18 months (range 2–35 months). The patients were evaluated through the Oswestry disability index, Zurich Claudication Questionnaire (ZCQ), VAS scales. In all cases were obtained preoperative and in postoperative radiographs and magnetic resonance imaging.ResultsThe VAS score decreased significantly after surgery: the patients presented a mean VAS of seven preoperatively and two postoperatively (p < 0.001).The ZCQ score significantly decreased postoperatively, with an average reduction of 21.89 % (p < 0.001).The ODI score as well showed a significant reduction postoperatively of an average 26.09 % (p < 0.001).ConclusionDespite of the brief follow up, the preliminary results are encouraging, showing a significantly decrease of the disability parameters, a marked improvement of the function with the vanishing of the claudicatio spinalis and the following increase of the free interval during the walk. Aperius PercLID system seems to offer an alternative to the traditional decompression surgery.
Highlights
Neurogenic intermittent claudication (NIC) secondary to lumbar spinal stenosis (LSS) is a degenerative disease prevalent in the population older than 50 years of age [1], with about 8 % of adult population affected by this pathology [2].The typical hyperextension of the affected spinal segment, caused by the gradual loss of disc height, leads to the annulus bulging, facets hypertrophy, spondylolisthesis, and calcification of the ligamentum flavum [3]
Purpose The purpose of this study is to report clinical outcome and imaging changes of percutaneous Aperius stand-alone implant in patients with degenerative lumbar spinal stenosis and neurogenic intermittent claudication, which did not respond to conservative treatment
As far as pain is concerned, statistical analysis showed a significant reduction after surgery in Visual Analog Scale (VAS) mean score from seven preoperative to two postoperative points (p \ 0.001), respectively
Summary
Neurogenic intermittent claudication (NIC) secondary to lumbar spinal stenosis (LSS) is a degenerative disease prevalent in the population older than 50 years of age [1], with about 8 % of adult population affected by this pathology [2].The typical hyperextension of the affected spinal segment, caused by the gradual loss of disc height, leads to the annulus bulging, facets hypertrophy, spondylolisthesis, and calcification of the ligamentum flavum [3]. Neurogenic intermittent claudication (NIC) secondary to lumbar spinal stenosis (LSS) is a degenerative disease prevalent in the population older than 50 years of age [1], with about 8 % of adult population affected by this pathology [2]. Patients with stability of symptoms are treated with conservative therapy first, reporting a success rate variable from 15 to 50 %. The failure of the conservative therapy has generally occurred 4–6 years after the onset of degenerative lumbar spinal stenosis symptoms, leaving decompression surgery as the only alternative treatment. The decompression surgery, with or without fusion, is reported to be more effective than conservative care in terms of pain relief and patient satisfaction [4]
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