A Differential Clinical Benefit Examination of Full Lumbar Endoscopy vs Interspinous Process Spacers in the Treatment of Spinal Stenosis: An Effect Size Meta-Analysis of Clinical Outcomes

Abstract

Study Design: a design-agnostic standardized effect meta-analysis of 48 randomized, prospective, and retrospective studies on clinical outcomes with spinal endoscopic and interspinous process spacer (iPs) surgery.Objective: the study aimed to provide reference set of oswestry disability index (odi) and visual analog scale (vas) effect size data for back and leg pain following endoscopic and iPs decompression for lumbar herniated disc, foraminal, or lateral recess spinal stenosis.Background: mechanical low back pain following endoscopic transforaminal decompression may be more reliably reduced by simultaneous posterior column stabilization with iPs.Methods: a systematic search of the Pubmed, embase, web of science, and the Cochrane Central register of Controlled trials from 1 January 2000 to 2 april 2020, identified 880 eligible endoscopy and 362 iPs studies varying in design and metrics. the authors compared calculated standardized effect sizes (Cohen's d) for extracted odi, vas-back, and vas-leg data.Results: the pooled standardized effect size combining the odi, vas-back, and vas-leg data for the total sample of 19862 data sets from the 30 endoscopy and 18 iPs was 0.877 (95% Ci = 0.857-0.898). when stratified by surgery, the combined effect sizes were 0.877 (95% Ci = 0.849-0.905) for endoscopic decompression and 0.863 (95% Ci = 0.796-0.930; P = 0.056) for iPs implantation. the odi effect sizes calculated on 6462 samples with directly visualized endoscopic decompression were 0.917 (95% Ci = 0.891-0.943) versus 0.798 (95% Ci = 0.713-0.883; P < 0.001) with indirect iPs decompression (P < 0.001). the vas-back effect sizes calculated on 3672 samples were 0.661 (95% Ci = 0.585-0.738) for endoscopy and 0.784 (95% Ci: 0.644-0.923; P = 0.187) for iPs. the vas-leg effect sizes calculated on 7890 samples were 0.885 (95% Ci = 0.852-0.917) for endoscopic decompression and 0.851 (95% Ci = 0.767-0.935; P = 0.427).Conclusion: Lumbar iPs implantation produces larger reduction in low back pain than spinal endoscopy. on the basis of this meta-analysis, the combination of lumbar transforaminal endoscopy with simultaneous iPs has merits and should be formally investigated in higher grade clinical studies.Clinical Relevance: meta-analysis on the added clinical benefit of combining lumbar endoscopic decompression with an interspinous process spacer.

Numerical Assessment of Interspinous Spacers for Lumbar Spine

“…Many ISPs have been designed for clinical use [33]. Many studies have been reported as a treatment for SDD [34][35][36][37]. Different clinical studies are required to corroborate the correct functioning of the implants.…”

Someec Consensus Statement Spine-Related Disease Burden and the Future of Endoscopic Spine Care

“…Luis Lombardi, Anthony Yeung, and Kai-Uwe Lewandrowski received special recognition awards as US-based corresponding foreign members for their collaborative publishing work with key Mexican opinion leaders. [4][5][6][7][8][9][10][11][12][13][14][15] Dr. Yeung was awarded a lifetime achievement award for his groundbreaking work that formed the basis for endoscopic spine surgery, having become mainstream in Latin America (Figure 5). Dr. Yeung was named honorary president of SOMEEC.…”

An Investigation of Revisional Surgery After Implantation of Device for Intervertebral Motion (DIAM): A Case Series Study

“…Moreover, this study observed that most revision surgery patients in our hospital have received multiple DIAM™ devices, which caused persistent back pain, lower leg numbness, and spinal instability leading to neural tube stenosis (Figure 3). Besides, these kinds of revision surgery are not difficult to perform because adhesions are found only in lamina decompression and are still the virgin site near the nerve root [23,24]. DIAM™ being a foreign body can cause infection in a few cases.…”