Association between degenerative spondylolisthesis and spinous process fracture after interspinous process spacer surgery

Kim, David H.; Shanti, Nael; Tantorski, Mark; Shaw, Jeremy D.; Li, Ling; Martha, Juli F.; Thomas, Arthur N.; Parazin, Stephen; Rencus, Tal; Kwon, Brian K.

doi:10.1016/j.spinee.2012.03.034

Cited by 46 publications

(32 citation statements)

References 7 publications

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“…They reported the fracture of spinous processes in 3 of 13 patients and suggested possible causes of fracture, including the degree of osteoporosis and over-distraction of the interspinous space with an oversized implant. Kim et al 8 reported a high rate (52%) of spinous process fracture associated with ISP surgery performed in 39 patients at their institution. One of the main reasons for spinous process fracture would be the stress concentration at the bone after ISP implantation.…”

Section: Discussionmentioning

confidence: 99%

“…Although spinous processes may be strong enough to withstand the stresses after implantation, 23 ISP devices may cause gradual erosion at the bone-implant interface under constant stress and motion, thereby increasing the recurrence probability of preoperative symptoms. In addition, the success rate of the outcome of lumbar treatment with an ISP device also depends largely on the bone density 8 and overall lumbar scoliosis 19 of patients. Like any other numerical study, this study has certain limitations.…”

Section: Discussionmentioning

confidence: 99%

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Determination of the biomechanical effect of an interspinous process device on implanted and adjacent lumbar spinal segments using a hybrid testing protocol: a finite-element study

Erbulut

Zafarparandeh²,

Hassan³

et al. 2015

SPI

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OBJECT The authors evaluated the biomechanical effects of an interspinous process (ISP) device on kinematics and load sharing at the implanted and adjacent segments. METHODS A 3D finite-element (FE) model of the lumbar spine (L1–5) was developed and validated through comparison with published in vitro study data. Specifically, validation was achieved by a flexible (load-control) approach in 3 main planes under a pure moment of 10 Nm and a compressive follower load of 400 N. The ISP device was inserted between the L-3 and L-4 processes. Intact and implanted cases were simulated using the hybrid protocol in all motion directions. The resultant motion, facet load, and intradiscal pressure after implantation were investigated at the index and adjacent levels. In addition, stress at the bone-implant interface was predicted. RESULTS The hybrid approach, shown to be appropriate for adjacent-level investigations, predicted that the ISP device would decrease the range of motion, facet load, and intradiscal pressure at the index level relative to the corresponding values for the intact spine in extension. Specifically, the intradiscal pressure induced after implantation at adjacent segments increased by 39.7% and by 6.6% at L2–3 and L4–5, respectively. Similarly, facet loads at adjacent segments after implantation increased up to 60% relative to the loads in the intact case. Further, the stress at the bone-implant interface increased significantly. The influence of the ISP device on load sharing parameters in motion directions other than extension was negligible. CONCLUSIONS Although ISP devices apply a distraction force on the processes and prevent further extension of the index segment, their implantation may cause changes in biomechanical parameters such as facet load, intradiscal pressure, and range of motion at adjacent levels in extension.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Determination of the biomechanical effect of an interspinous process device on implanted and adjacent lumbar spinal segments using a hybrid testing protocol: a finite-element study

Erbulut

Zafarparandeh²,

Hassan³

et al. 2015

SPI

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“…Because the role of the LSP in pathogenesis of low back pain remains unclear, the findings of our study may have valuable clinical implications. Recently, ISPD have been used as an alternative solution to the conventional decompressive surgery for DDD, lumbar spinal stenosis caused by degenerative lumbar spondylolisthesis (DLS) [27,28]. Promising clinical outcomes have been reported.…”

Section: Discussionmentioning

confidence: 99%

“…However, there are also studies reporting that the interspinous implants may result in complications, including implant migration and spinous process fracture [4,27,28]. Kim et al [27,29] indicated that degenerative lumbar spondylolisthesis appears strongly associated with the occurrence of spinous process fracture after interspinous process spacer (IPS) surgery. Current kinematic studies indicate that for elderly patients with Grade 1 DLS, not only the shortest ISP distance but also the range of the shortest ISP distance change decreased during active in vivo function of the body.…”

Section: Discussionmentioning

confidence: 99%

Motion characteristics of the lumbar spinous processes with degenerative disc disease and degenerative spondylolisthesis

et al. 2013

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Objective Recently, interspinous process devices have attracted much attention since they can be implanted between the lumbar spinous processes (LSP) of patients with degenerative disc disease (DDD) and degenerative spondylolisthesis (DLS) using a minimally invasive manner. However, the motion characters of the LSP in the DLS and DDD patients have not been reported. This study is aimed at investigating the kinematics of the lumbar spinous processes in patients with DLS and DDD. Methods Ten patients with DDD at L4-S1 and ten patients with DLS at L4-L5 were studied. The positions of the vertebrae (L2-L5) at supine, standing, 45°trunk flexion, and maximal extension positions were determined using MRI-based models and dual fluoroscopic images. The shortest ISP distances were measured and compared with those of healthy subjects that have been previously reported.Results The shortest distance of the interspinous processes (ISP) gradually decreased from healthy subjects to DDD and to DLS patients when measured in the supine, standing, and extension positions. During supine-standing and flexion-extension activities, the changes in the shortest ISP distances in DDD patients were 2 ± 1.2 and 4.8 ± 2.1 mm at L4-L5; in DLS patients they were 0.5 ± 0.4 and 2.8 ± 1.7 mm at L4-L5, respectively. The range of motion is increased in DDD patients but decreased in DLS patients when compared with those of the healthy subjects. No significantly different changes were detected at L2-L3 and L3-L4 levels. Conclusion At the involved level, the hypermobility of the LSP was seen in DDD and hypomobility of the LSP in DLS patients. The data may be instrumental for improving ISP surgeries that are aimed at reducing post-operative complications such as bony fracture and device dislocations.

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“…The selection of an interspinous fusion spacer as a suitable option needs to be carefully evaluated since the incidence of complications may be associated with the device's indication. For example, Kim et al 9 observed an association between spinous process fracture recurrence and degenerative spondylolisthesis. Even though their study included 2 dynamic spacers (X-STOP Titanium, X-STOP polyaryletheretherketone) and 1 interspinous fusion device (Aspen), an association between fractures and device design could not be established; however, this study only included 8 patients treated with the interspinous fusion device (of 38 patients total), which limits the analysis of dynamic versus fusion devices.…”

Section: Clinical Complications Of Interspinous Spacersmentioning

confidence: 99%

Biomechanical analysis of an interspinous fusion device as a stand-alone and as supplemental fixation to posterior expandable interbody cages in the lumbar spine

Gonzalez-Blohm

Doulgeris

Aghayev

et al. 2014

SPI

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Object In this paper the authors evaluate through in vitro biomechanical testing the performance of an interspinous fusion device as a stand-alone device, after lumbar decompression surgery, and as supplemental fixation to expandable cages in a posterior lumbar interbody fusion (PLIF) construct. Methods Nine L3–4 human cadaveric spines were biomechanically tested under the following conditions: 1) intact/control; 2) L3–4 left hemilaminotomy with partial discectomy (injury); 3) interspinous spacer (ISS); 4) bilateral pedicle screw system (BPSS); 5) bilateral hemilaminectomy, discectomy, and expandable posterior interbody cages with ISS (PLIF-ISS); and 6) PLIF-BPSS. Each test consisted of 100 N of axial preload with ± 7.5 Nm of torque in flexion-extension, right/left lateral bending, and right/left axial rotation. Significant changes in range of motion (ROM), neutral zone stiffness (NZS), elastic zone stiffness (EZS), and energy loss (EL) were explored among conditions using nonparametric Friedman test and Wilcoxon signed-rank comparisons (p ≤ 0.05). Results The injury increased ROM in flexion (p = 0.01), left bending (p = 0.03), and right/left rotation (p < 0.01) and also decreased NZS in flexion (p = 0.01) and extension (p < 0.01). Both the ISS and BPSS reduced flexion-extension ROM and increased flexion-extension stiffness (NZS and EZS) with respect to the injury and intact conditions (p < 0.05), but the ISS condition provided greater resistance than BPSS in extension for ROM, NZS, and EZS (p < 0.01). The BPSS increased the rigidity (ROM, NZS, and EZS) of the intact model in lateral bending and axial rotation (p ≤ 0.01), except in EZS for left rotation (p = 0.23, Friedman test). The incorporation of posterior cages marginally increased (p = 0.05) the EZS of the BPSS construct in flexion but these interbody devices provided significant stability to the ISS construct in lateral bending and axial rotation for ROM (p = 0.02), in lateral bending for NZS (p = 0.02), and in flexion/axial rotation for EZS (p ≤ 0.03); however, both PLIF constructs demonstrated equivalent ROM and stiffness (p ≥ 0.16), except in lateral bending where the PLIF-BPSS was more stable (p = 0.02). In terms of EL, the injury increased EL in flexion-extension (p = 0.02), the ISS increased EL for lateral bending and axial rotation (p ≤ 0.03), and the BPSS decreased EL in lateral bending (p = 0.02), with respect to the intact condition. The PLIF-ISS decreased lateral bending EL with respect to the ISS condition (p = 0.02), but not enough to be smaller or, at least, equivalent, to that of the PLIF-BPSS construct (p = 0.02). Conclusions The ISS may be a suitable device to provide immediate flexion-extension balance after a unilateral laminotomy, but the BPSS provides greater immediate stability in lateral bending and axial rotation motions. Both PLIF constructs performed equivalently in flexion-extension and axial rotation, but the PLIF-BPSS construct is more resistant to lateral bending motions. Further biomechanical and clinical evidence is required to strongly support the recommendation of a stand-alone interspinous fusion device or as supplemental fixation to expandable posterior interbody cages.

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Association between degenerative spondylolisthesis and spinous process fracture after interspinous process spacer surgery

Cited by 46 publications

References 7 publications

Determination of the biomechanical effect of an interspinous process device on implanted and adjacent lumbar spinal segments using a hybrid testing protocol: a finite-element study

Determination of the biomechanical effect of an interspinous process device on implanted and adjacent lumbar spinal segments using a hybrid testing protocol: a finite-element study

Motion characteristics of the lumbar spinous processes with degenerative disc disease and degenerative spondylolisthesis

Biomechanical analysis of an interspinous fusion device as a stand-alone and as supplemental fixation to posterior expandable interbody cages in the lumbar spine

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