Interspinous Process Research Articles

Interspinous process segmental spinal instrumentation for scoliosis in cerebral palsy.

Interspinous process segmental instrumentation (ISSI) was used in 34 patients with scoliosis due to severe cerebral palsy. Average age was 17 years, and average curve was 82 degrees. Anterior fusion was performed in 21 patients before ISSI. Mean correction was 50.5%, and progression averaged 5 degrees at the 22-month follow-up. Posterior fusion alone gave good results in smaller curves. A brace was needed only for severe movement disorders. Gross functional level improved in fewer than one-third of patients. Minor gains were made by 74%. ISSI is effective in severe cerebral palsy. It may be used alone in the smaller (less than 80 degrees), more supple curves.

The physiology and degeneration of joints

There is a growing impetus to treat aging as a disease in the quest to significantly extend the human life span through cellular regeneration methods. This approach, while promising, overlooks the fact that the evolutionary adaptation to bipedalism puts the human body in a distinctively vulnerable biomechanical and functional position. Orthograde human posture places unusually-high axial compressive loads on the weight-bearing joints of the skeleton, resulting in arthritic deterioration with aging. The effects are particularly robust in the lumbar spine were age-related degeneration, most commonly lumbar spinal stenosis (LSS), is ubiquitous among the elderly. It is postulated that re-establishing a favorable mechanical environment via interventions that unload the affected spinal joint complex may mitigate and potentially reverse the structural damage that is the cardinal pathoanatomical feature of this disease. The hypothesis of this paper is that a minimally-invasive surgical procedure, interspinous process decompression (IPD), which utilizes a stand-alone intervertebral spacer, effectively unloads the diseased spinal motion segment providing a healthy micro-environment to reverse and repair age-related and genetic deterioration of the spinal motion segment. Several lines of supporting evidence are provided from long-term follow-up results of a randomized controlled trial of IPD safety and effectiveness of the Superion® device including clinical outcomes, reoperation rates, opioid analgesic usage and advanced imaging utilization. All of these outcomes show uniquely-favorable trends with time that imply that the benefits of IPD are structural. The compendium of evidence suggests that IPD offers both a durable palliative effect due to direct blocking of back extension and a disease-modifying effect due to unloading of the spinal joint complex.