Interspinous spacers for lumbar foraminal stenosis: formal trials are justified

Hobart, Jeremy; Gilkes, Catherine; Adams, William M.; Germon, Tim

doi:10.1007/s00586-012-2650-z

Cited by 7 publications

(8 citation statements)

References 21 publications

(24 reference statements)

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“…Our eligibility criteria permitted only five studies to be included in our meta-analysis. Although the included sample size was not large, it is larger than most other studies of dynamic device use for the management of lumbar spinal stenosis [24] , [25] . All of the included studies were prospective and comparatively designed, and two were RCTs [13] .…”

Section: Discussionmentioning

confidence: 99%

Interspinous Spacer versus Traditional Decompressive Surgery for Lumbar Spinal Stenosis: A Systematic Review and Meta-Analysis

Zhou

et al. 2014

PLoS ONE

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BackgroundDynamic interspinous spacers, such as X-stop, Coflex, DIAM, and Aperius, are widely used for the treatment of lumbar spinal stenosis. However, controversy remains as to whether dynamic interspinous spacer use is superior to traditional decompressive surgery.MethodsMedline, Embase, Cochrane Library, and the Cochrane Controlled Trials Register were searched during August 2013. A track search was performed on February 27, 2014. Study was included in this review if it was: (1) a randomized controlled trial (RCT) or non-randomized prospective comparison study, (2) comparing the clinical outcomes for interspinous spacer use versus traditional decompressive surgery, (3) in a minimum of 30 patients, (4) with a follow-up duration of at least 12 months.ResultsTwo RCTs and three non-randomized prospective studies were included, with 204 patients in the interspinous spacer (IS) group and 217 patients in the traditional decompressive surgery (TDS) group. Pooled analysis showed no significant difference between the IS and TDS groups for low back pain (WMD: 1.2; 95% CI: −10.12, 12.53; P = 0.03; I2 = 66%), leg pain (WMD: 7.12; 95% CI: −3.88, 18.12; P = 0.02; I2 = 70%), ODI (WMD: 6.88; 95% CI: −14.92, 28.68; P = 0.03; I2 = 79%), RDQ (WMD: −1.30, 95% CI: −3.07, 0.47; P = 0.00; I2 = 0%), or complications (RR: 1.39; 95% CI: 0.61, 3.14; P = 0.23; I2 = 28%). The TDS group had a significantly lower incidence of reoperation (RR: 3.34; 95% CI: 1.77, 6.31; P = 0.60; I2 = 0%).ConclusionAlthough patients may obtain some benefits from interspinous spacers implanted through a minimally invasive technique, interspinous spacer use is associated with a higher incidence of reoperation and higher cost. The indications, risks, and benefits of using an interspinous process device should be carefully considered before surgery.

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Section: Discussionmentioning

confidence: 99%

Interspinous Spacer versus Traditional Decompressive Surgery for Lumbar Spinal Stenosis: A Systematic Review and Meta-Analysis

Zhou

et al. 2014

PLoS ONE

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“…[13][14][15][16][17] Results from randomized, multicenter trials clearly demonstrate that the interspinous device improves clinical symptoms and function significantly compared with epidural steroid injections and conservative therapy in patients with symptoms of neurogenic intermittent claudication. 18,19 Our findings are in agreement with these data and further provide the opportunity to compare patients with LDH in whom the interspinous system has been inserted following microdiscectomy with a control group.…”

Section: Discussionmentioning

confidence: 99%

Clinical analysis following lumbar interspinous devices implant: where we are and where we go

2014

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“…Recently, numerous stabilizing devices have been introduced in the spinal arena. Common features of these non-fusion (dynamic stabilizing) implants include retention and protection of the intervertebral disc and most of the soft tissues and bony structures of the posterior spine, application of minimally invasive technique, short operative time, earlier surgical intervention, preservation of the motion (versus fusion), and therefore a reduction in the probability of adjacent segment disease [ 59 ]. These devices may be used alone or in combination with other decompression surgeries.…”

Section: Non-fusion Techniques For Treatment Of Lssmentioning

confidence: 99%

Lumbar Spinal Stenosis: Who Should Be Fused? An Updated Review

2014

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Lumbar spinal stenosis (LSS) is mostly caused by osteoarthritis (spondylosis). Clinically, the symptoms of patients with LSS can be categorized into two groups; regional (low back pain, stiffness, and so on) or radicular (spinal stenosis mainly presenting as neurogenic claudication). Both of these symptoms usually improve with appropriate conservative treatment, but in refractory cases, surgical intervention is occasionally indicated. In the patients who primarily complain of radiculopathy with an underlying biomechanically stable spine, a decompression surgery alone using a less invasive technique may be sufficient. Preoperatively, with the presence of indicators such as failed back surgery syndrome (revision surgery), degenerative instability, considerable essential deformity, symptomatic spondylolysis, refractory degenerative disc disease, and adjacent segment disease, lumbar fusion is probably recommended. Intraoperatively, in cases with extensive decompression associated with a wide disc space or insufficient bone stock, fusion is preferred. Instrumentation improves the fusion rate, but it is not necessarily associated with improved recovery rate and better functional outcome.

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Interspinous spacers for lumbar foraminal stenosis: formal trials are justified

Cited by 7 publications

References 21 publications

Interspinous Spacer versus Traditional Decompressive Surgery for Lumbar Spinal Stenosis: A Systematic Review and Meta-Analysis

Interspinous Spacer versus Traditional Decompressive Surgery for Lumbar Spinal Stenosis: A Systematic Review and Meta-Analysis

Clinical analysis following lumbar interspinous devices implant: where we are and where we go

Lumbar Spinal Stenosis: Who Should Be Fused? An Updated Review

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