Abstract
BackgroundBest practice guidelines for treating lumbar stenosis include a multidisciplinary approach, ranging from conservative management with physical therapy, medication, and epidural steroid injections to surgical decompression with or without instrumentation. Marketed as an outpatient alternative to a traditional lumbar decompression, interspinous process devices (IPDs) have gained popularity as a minimally invasive stabilization procedure. IPDs have been embraced by non-surgical providers, including physiatrists and anesthesia interventional pain specialists. In the interest of patient safety, it is imperative to formally profile its safety and identify its role in the treatment paradigm for lumbar stenosis.Case DescriptionWe carried out a retrospective review at our institution of neurosurgical consultations for patients with hardware complications following the interspinous device placement procedure. Eight cases within a 3-year period were identified, and patient characteristics and management are illustrated. The series describes the migration of hardware, spinous process fracture, and worsening post-procedural back pain.ConclusionsIPD placement carries procedural risk and requires a careful pre-operative evaluation of patient imaging and surgical candidacy. We recommend neurosurgical consultation and supervision for higher-risk IPD cases.
Highlights
Degenerative lumbar stenosis is a condition resulting from severe narrowing of the spinal canal and often manifests as neurogenic claudication: back and/or leg pain exacerbated by load-bearing activity and lumbar extension, and improved symptoms with rest or flexion
We examined the timing of surgical consultation and its effect
Visual analog scale (VAS) pain scores decreased from a mean of 8.4 on initial consultation to 5.6 at last follow-up
Summary
Degenerative lumbar stenosis is a condition resulting from severe narrowing of the spinal canal and often manifests as neurogenic claudication: back and/or leg pain exacerbated by load-bearing activity and lumbar extension, and improved symptoms with rest or flexion. Developed as an alternative to decompressive laminectomy, interspinous process devices (IPDs) are an emerging technology in treating lumbar stenosis. Neurosurgical Management of Interspinous Device Complications to limit the extension between two spinal levels, in turn preventing symptomatic exacerbation of lumbar stenosis. Best practice guidelines for treating lumbar stenosis include a multidisciplinary approach, ranging from conservative management with physical therapy, medication, and epidural steroid injections to surgical decompression with or without instrumentation. Marketed as an outpatient alternative to a traditional lumbar decompression, interspinous process devices (IPDs) have gained popularity as a minimally invasive stabilization procedure. Case Description: We carried out a retrospective review at our institution of neurosurgical consultations for patients with hardware complications following the interspinous device placement procedure. The series describes the migration of hardware, spinous process fracture, and worsening post-procedural back pain
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