Interspinous process spacers versus traditional decompression for lumbar spinal stenosis: systematic review and meta-analysis

Phan, Kevin; Rao, Prashanth J.; Ball, Jonathon; Mobbs, Ralph J.

doi:10.21037/jss.2016.01.07

Cited by 40 publications

(36 citation statements)

References 42 publications

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“…Also, he concluded that the use of interspinous spacers did not appear to significantly change the clinical result of the surgery from that expected from decompression alone. Similar results are drawn from a metanalysis by Phan et al (11) finding no superiority for IPDs compared with traditional decompression, but higher reoperation rates and costs.…”

Section: Discussionsupporting

confidence: 81%

Long-term results with percutaneous interspinous process devices in the treatment of neurogenic intermittent claudication

Fransen

2017

J. Spine Surg.

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Despite initial satisfactory results, long-term FU is disappointing, with 80% poor or average results. The long-term reoperation rate is high (66.6%), increases over time and is higher than after implantation of IPDs for decompression augmentation. Although this technique is simple and safe, its effectiveness seems short-lived. We recommend cautious use and informing patients about the risk of relatively early failure and recurrence.

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Section: Discussionsupporting

confidence: 81%

Long-term results with percutaneous interspinous process devices in the treatment of neurogenic intermittent claudication

Fransen

2017

J. Spine Surg.

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“…Phan et al[ 17 ] included RCTs and prospective observational studies, limited to the English language. They found no superiority of IPDs compared to decompression and also found a higher reoperation rate in the IPD group.…”

Section: Discussionmentioning

confidence: 99%

“…Randomized controlled trials (RCT) have compared IPDs to conservative treatment [ 7 – 9 ] or to standard surgery[ 10 – 16 ], but there is an overall concern regarding bias risks and small population samples. Four systematic reviews have been published[ 17 – 20 ], but only one of these reviews examined exclusively RCTs[ 19 ]. Nevertheless, this systematic review included only 4 of the available studies.…”

Section: Introductionmentioning

confidence: 99%

Interspinous process devices for treatment of degenerative lumbar spine stenosis: A systematic review and meta-analysis

et al. 2018

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BackgroundDegenerative lumbar spinal stenosis is a condition related to aging in which structural changes cause narrowing of the central canal and intervertebral foramen. It is currently the leading cause for spinal surgery in patients over 65 years. Interspinous process devices (IPDs) were introduced as a less invasive surgical alternative, but questions regarding safety, efficacy, and cost-effectiveness are still unanswered.ObjectivesThe aim of this study was to provide complete and reliable information regarding benefits and harms of IPDs when compared to conservative treatment or decompression surgery and suggest directions for forthcoming RCTs.MethodsWe searched MEDLINE, EMBASE, Cochrane Library, Scopus, and LILACS for randomized and quasi-randomized trials, without language or period restrictions, comparing IPDs to conservative treatment or decompressive surgery in adults with symptomatic degenerative lumbar spine stenosis. Data extraction and analysis were conducted following the Cochrane Handbook. Primary outcomes were pain assessment, functional impairment, Zurich Claudication Questionnaire, and reoperation rates. Secondary outcomes were quality of life, complications, and cost-effectiveness. This systematic review was registered at Prospero (International prospective register of systematic reviews) under number 42015023604.ResultsThe search strategy resulted in 17 potentially eligible reports. At the end, nine reports were included and eight were excluded. Overall quality of evidence was low. One trial compared IPDs to conservative treatment: IPDs presented better pain, functional status, quality of life outcomes, and higher complication risk. Five trials compared IPDs to decompressive surgery: pain, functional status, and quality of life had similar outcomes. IPD implant presented a significantly higher risk of reoperation. We found low-quality evidence that IPDs resulted in similar outcomes when compared to standard decompression surgery. Primary and secondary outcomes were not measured in all studies and were often published in incomplete form. Subgroup analysis was not feasible. Difficulty in contacting authors may have prevented us of including data in quantitative analysis.ConclusionsPatients submitted to IPD implants had significantly higher rates of reoperation, with lower cost-effectiveness. Future trials should improve in design quality and data reporting, with longer follow-up periods.

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“…The meta -analyses showed no significant difference on clinical outcomes in comparison with decompressive surgery. Additionally ISD has higher incidence of long -term reoperation and might lead to burden of cost [20,21]. Furthermore biomechanical changes such as decrease in ROM, and increase of interdiscal pressure and facet load at the adjacent segment following implantation of ISD are reported in both finite element and in vitro biomechanical studies [22,23].…”

Section: Discussionmentioning

confidence: 99%

Perspective of Lumbar Segmental Instability for Surgical Evalua tion of Lumbar Disc Herniation

Egemen¹,

Süzer²,

Yaman³

et al. 2017

J Spine

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Surgery of lumbar disc herniation is most common procedure in neurosurgical practice. However poor outcomes, recurrent disc herniation and recurrence of low back and leg pain which affect quality of life, are still challenging. Lumbar spine instability develops as a result of a gradual degenerative process and lumbar segmental instability is one of main reason of failed back surgery. Presence of lumbar segmental instability or potential secondary instability after surgery should not be overlooked. Accurate preoperative evaluation of patients with lumbar disc herniation needs to understand biomechanics of spinal stability and predict possible result of postoperative instability. Thus failure of treatment modalities can be avoided.

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Interspinous process spacers versus traditional decompression for lumbar spinal stenosis: systematic review and meta-analysis

Abstract: Current evidence indicates no superiority for mid- to long-term patient-reported outcomes for IPD compared with traditional bony decompression, with lesser surgical complications but at the risk of significantly higher reoperation rates and costs.

Cited by 40 publications

References 42 publications

Long-term results with percutaneous interspinous process devices in the treatment of neurogenic intermittent claudication

Long-term results with percutaneous interspinous process devices in the treatment of neurogenic intermittent claudication

Interspinous process devices for treatment of degenerative lumbar spine stenosis: A systematic review and meta-analysis

Perspective of Lumbar Segmental Instability for Surgical Evalua tion of Lumbar Disc Herniation

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