Patient Outcomes After Single-level Coflex Interspinous Implants Versus Single-level Laminectomy

Abstract

Study Design. Retrospective cohort analysis.Objective. The aim of this study was to compare postoperative outcomes of Coflex interspinous device versus laminectomy. Summary of Background Data. Coflex Interlaminar Stabilization device (CID) is indicated for one-or two-level lumbar stenosis with grade 1 stable spondylolisthesis in adult patients, as an alternative to laminectomy, or laminectomy and fusion. CID provides stability against progressive spondylolisthesis, retains motion, and prevents further disc space collapse. Methods. Patients !18 years' old with lumbar stenosis and grade 1 stable spondylolisthesis who underwent either primary single-level decompression and implantation of CID, or singlelevel laminectomy alone were included with a minimum 90-day follow-up at a single academic institution. Clinical characteristics, perioperative outcomes, and postoperative complications were reviewed until the latest follow-up. x 2 and independent samples t tests were used for analysis. Results. Eighty-three patients (2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018)(2019) were included: 37 cases of single-level laminectomy (48.6% female) were compared to 46 single-level CID (50% female). CID cohort was older (CID 69.0 AE 9.4 vs. laminectomy 64.2 AE 11.0, P ¼ 0.042) and had higher American Society of Anesthesiologists (ASA) grade (CID 2.59 AE 0.73 vs. laminectomy 2.17 AE 0.48, P ¼ 0.020). CID patients had higher estimated blood loss (EBL) (97.50 AE 77.76 vs. 52.84 AE 50.63 mL, P ¼ 0.004), longer operative time (141.91 AE 47.88 vs. 106.81 AE 41.30 minutes, P ¼ 0.001), and longer length of stay (2.0 AE 1.5 vs. 1.1 AE 1.0 days, P ¼ 0.001). Total perioperative complications (21.7% vs. 5.4%, P ¼ 0.035) and instrumentation-related complication was higher in CID (10.9% vs. 0% laminectomy group, P ¼ 0.039). There were no other significant differences between the groups in demographics or outcomes. Conclusion. Single-level CID devices had higher perioperative 90-day complications, longer operative time, length of stay, higher EBL compared to laminectomies alone. Similar overall revision and neurologic complication rates were noted compared to laminectomy at last follow-up.

Bibliometric analysis of interspinous device in treatment of lumbar degenerative diseases

“…Doo et al [32] conducted a clinical trial and showed that Coflex was indicated for patients with lumbar spinal stenosis with mild associated segmental instability and had less effect on adjacent segments than conventional posterior lumbar interbody fusion (PLIF) procedures. In their retrospective study, Zhong et al [33] examined 83 patients and observed that the utilization of single-level Coflex was linked to elevated rates of overall complications, longer operative time, and extended hospital stay within a three-month period in comparison to fenestration decompression alone. The StenoFix system, akin to the Coflex system, exhibits a “w” shape from a lateral perspective, thereby enabling it to withstand greater axial loads.…”

Comparison of Coflex dynamic stabilization with BacFuse static stabilization for lumbar degenerative disease

“…Interspinous process devices expand the aperture of the intervertebral foramina and maintain partial segmental range of motion, achieving a good balance between adequate decompression and stability [13,14] . First introduced in 1994, Co ex dynamic interlaminar stabilization has been shown to provide results comparable to those of surgical decompression and fusion and can be regarded as an effective alternative treatment [15][16][17] . BacFuse is another interspinous process device which differs from Co ex in two ways.…”

Efficacy and safety of interspinous process device compared with alone decompression for lumbar spinal stenosis: A systematic review and meta-analysis

“…[32] 2016 55/51.8 28/25 Coflex Decompression 12/12 Jack, Z. [33] 2021 69/64. CI: −4.75-1.03, P = .21; Fig.…”