Occult Spinous Process Fractures Associated With Interspinous Process Spacers

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

doi:10.1097/brs.0b013e318204066a

Cited by 70 publications

(40 citation statements)

References 9 publications

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“…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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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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“…Zucherman et al [9] reported good functional improvement and pain relief after the implantation of interspinous spacers. However, Bowers et al [10] noted that the procedure carried a high rate of complications, which was separately reported by Kim et al [11].…”

Section: Introductionmentioning

confidence: 91%

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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“…[13591014] Single-level devices were implanted in 343 cases, while two-level IFDs were placed in 41 cases. [13591014] Patients were followed for an average of 23 months, and up to 4 years. [131014]…”

Section: Complications Reoperation Rates and Poor Outcomes Attributmentioning

confidence: 99%

“…[13591014] In the first study, the complication rate for IFD (X-STOP) in 13 patients was 38%. [3] X-STOP devices were implanted at the L4–L5 (nine patients) and at both the L3–L4 and L4–L5 levels (four patients).…”

Section: Complications Reoperation Rates and Poor Outcomes Attributmentioning

confidence: 99%

A review of interspinous fusion devices: High complication, reoperation rates, and costs with poor outcomes

Epstein

2012

Surg Neurol Int

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Background:Interspinous fusion devices (IFDs) are increasingly offered to patients over the age of 50 with lumbar spinal stenosis and intermittent neurogenic claudication. Here, we review the literature on complication rates, reoperation rates, and outcomes for implanting IFD, and offer an assessment of IFD charges at a single institution in 2010.Methods:The literature concerning IFD implants was reviewed with particular attention focused on complications, reoperation rates, and outcomes. Additionally, the costs of implanting 31 IFD devices in 16 patients at one to three levels at a single institution in 2010 are presented.Results:Reviewing the spinal literature concerning the postoperative status of IFD followed over an average of 23–42.9 postoperative months revealed that IFD resulted in 11.6–38% complication rate, 4.6–85% reoperation rate, and 66.7–77% frequency of poor outcomes. Additionally, the 31 devices implanted in 16 patients at a single university hospital in 2010 cost a total of $576,407.Conclusions:With high maximal complication rates (38%), reoperation rates (85%), poor outcomes (77%), and high costs ($576,407 for 31 devices in 16 patients), the utilization and implantation of IFD remains extremely controversial and should be investigated further.

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Occult Spinous Process Fractures Associated With Interspinous Process Spacers

Cited by 70 publications

References 9 publications

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

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

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

A review of interspinous fusion devices: High complication, reoperation rates, and costs with poor outcomes

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