Interspinous process decompression is associated with a reduction in opioid analgesia in patients with lumbar spinal stenosis

Abstract

BackgroundLumbar spinal stenosis (LSS) causes significant pain and functional impairment, and medical management has increasingly included the prescription of opioid-based analgesics. Interspinous process decompression (IPD) provides a minimally-invasive treatment option for LSS.MethodsThis study estimated the type, dosage, and duration of opioid medications through 5 years of follow-up after IPD with the Superion Indirect Decompression System (Vertiflex Inc., Carlsbad, CA USA). Data were obtained from the Superion-treatment arm of a randomized controlled noninferiority trial. The prevalence of subjects using opiates was determined at baseline through 60 months. Primary analysis included all 190 patients randomized to receive the Superion device. In a subgroup of 98 subjects, we determined opioid-medication prevalence among subjects with a history of opioid use.ResultsAt baseline, almost 50% (94 of 190) of subjects were using opioid medication. Thereafter, there was a sharp decrease in opioid-medication prevalence from 25.2% (41 of 163) at 12 months to 13.3% (20 of 150) at 24 months to 7.5% (8 of 107) at 60 months. Between baseline and 5 years, there was an 85% decrease in the proportion of subjects using opioids. A similar pattern was also observed among subjects with a history of opiates prior to entering the trial.ConclusionStand-alone IPD is associated with a marked decrease in the need for opioid medications to manage symptoms related to LSS. In light of the current opiate epidemic, such alternatives as IPD may provide effective pain relief in patients with LSS without the need for opioid therapy.

Self-Administered Skills-Based Virtual Reality Intervention for Chronic Pain: Randomized Controlled Pilot Study

“…Research has shown that interspinous process spacer devices can provide relief for patients with lumbar spinal stenosis with neuroclaudication. 237,238 Regenerative/adult autologous stem cell therapy may show promise in the treatment of multiple painful conditions. -241 Further research is needed and encouraged to investigate the potential of these therapies.…”

Neurosurgical Management of Interspinous Device Complications: A Case Series

“…Several IPD brands are available, including X-STOP (Medtronic, Minneapolis, MN), Coflex (Paradigm Spine, New York, NY), Helifix (Alphatec, Carlsbad, CA), Stenofix (Depuy Synthes, Raynham, MA), FLEXUS (Globus, Audubon, PA), Device for Intervertebral Assisted Motion (DIAM) (Medtronic, Minneapolis, MN), Aperius (Medtronic, Minneapolis, MN), Wallis (Zimmer Biomet, Warsaw, IN), and the Superion (Vertiflex/Boston Scientific, Marlborough, MA) (2)(3)(4). Efficacy studies have shown an improvement in back and leg pain, functional outcome scores, and reduced the opioid medication requirement compared to conservative therapy (5)(6)(7)(8)(9)(10)(11). However, the optimal role of IPDs relative to surgical decompression remains unclear (12,13).…”

Novel Application of Erector Spinae Plane Block to Interspinous Spacer Placement

“…To our knowledge, it has not been applied for periprocedural analgesia of minimally invasive interspinous space decompression. Interspinous decompression is increasingly a treatment option for symptomatic lumbar spinal stenosis, with clinical evidence suggesting reduction in opioid analgesia requirements [ 2 ] and sustained five-year outcome improvements in function and quality of life [ 3 ]. In particular, interspinous spacers are finding a role as a percutaneous alternative to surgical options for elderly patients who may have significant medical co-morbidities that may preclude more open or extensive surgical procedures [ 4 ].…”