Percutaneous Interspinous Spacer in Spinal-Canal-Stenosis Treatment: Pros and Cons.

Chiara Zini,Matteo Bellini,Salvatore Masala,Stefano Marcia

doi:10.3390/medicina55070381

Abstract

A comprehensive description of the literature regarding interspinous process devices (IPD) mainly focused on comparison with conservative treatment and surgical decompression for the treatment of degenerative lumbar spinal stenosis. Recent meta-analysis and articles are listed in the present article in order to establish IPD pros and cons.

Highlights

In a case of “lack of success”, Meyer et al suggested that it is almost related to patient selection and biomechanical reasons [24]; Moojen et al suggested that the cross-sectional area of the spinal canal may be inferior after interspinous process devices (IPD) placement if compared to surgical laminectomy, leading to earlier symptom relapse in those patients with severe Degenerative lumbar spinal stenosis (DLSS) treated with IPD [22]
IPD are diverse mini-invasive devices placed with fluoroscopic guidance under local anesthesia between the spinal processes at the DLSS level in order to obtain nerve decompression
It has been demonstrated to be more effective than a conservative treatment for DLSS; treatment failure appeared to be significantly lower in the IPD group, while complications seemed to be more frequent for the implant group compared to the conservative treatment [15,16,17]

Summary

Introduction

Degenerative lumbar spinal stenosis (DLSS) is defined as the narrowing of the lumbar spinal canal, lateral nerve roots, and/or intervertebral neural foramina due to the progressive hypertrophy of any of the surrounding osteocartilaginous and ligamentous elements, resulting in neural and/or vascular compression and leading to neurogenic intermittent claudication (NIC) [1,2]. Because of surgery-related risks, patient comorbidities, and good results demonstrated in terms of outcomes, non-responders to conservative therapy are frequently treated with percutaneous treatments [8,9,10,11]. Medicina 2019, 55, 381 facet joint and posterior annulus, resulting in the restoration of normal foraminal height, was reported in cadaveric studies after IPD placement [12,13]. Complications such as dislocation and remodeling/fracture of the spinous process after. The aim of this paper was to provide complete and reliable information regarding the benefits and limits of IPD compared to conservative therapy and the surgical approach

Study Design

IPD: Pros and Cons

Findings

Conclusions