Understanding the value of minimally invasive procedures for the treatment of lumbar spinal stenosis: the case of interspinous spacer devices

Tapp, Stephanie; Martin, Brook I.; Tosteson, Tor D.; Lurie, Jon D.; Weinstein, Milton C.; Deyo, Richard A.; Mirza, Sohail K.

doi:10.1016/j.spinee.2017.08.246

Cited by 15 publications

(17 citation statements)

References 28 publications

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“…The traditional approach is to remove the lamina (laminectomy) and parts of the facet joint (medial facetectomy) to decompress the neural structures. Recently, less invasive techniques, such as microsurgical decompression and interspinous process spacer devices have emerged 10,11,12 . To avoid spinal instability some surgeons prefer to supplement the surgical decompression with an arthrodesis (fusion).…”

Section: Introductionmentioning

confidence: 99%

The Rates of LSS Surgery in Norwegian Public Hospitals

Grøvle

Fjeld

Haugen

et al. 2019

Spine

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Study DesignRetrospective administrative database study ObjectiveTo assess temporal and regional trends, and length of hospital stay, in lumbar spinal stenosis (LSS) surgery in Norwegian public hospitals from 1999 to 2013. Summary of Background DataStudies from several countries have reported increasing rates of LSS surgery over the last decades. No such data have been presented from Norway. MethodsA database consisting of discharges from all Norwegian public hospitals was established.Inclusion criteria were discharges including a surgical procedure of lumbar spinal decompression and/or fusion in combination with an ICD-10 diagnosis of Spinal Stenosis (M48.0) or Other Spondylosis with Radiculopathy (M47.2), and a patient age of 18 years or older. Discharges with diagnoses indicating deformity, i.e. spondylolisthesis or scoliosis were not included. ResultsDuring the 15-year period, 19 543 discharges were identified. The annual rate of decompressions increased from 10.7 to 36.2 and fusions increased from 2.5 to 4.4 per 100 000 people of the general Norwegian population. The proportion of fusion surgery decreased from 19.3% to 10.9%. Among individuals older than 65 years, the annual rate of surgery per 10000, including both decompressions and fusions, more than quadrupled from 40.2 to 170.3. The regional variation was modest, differing with a factor of 1.4 between the region with the highest and the lowest surgical rates. The mean length of hospital stay decreased from 11.0 (SD 8.0) days in 1999 to 5.0 (4.6) days in 2013, but patients who received fusion surgery stayed on average 3.6 days longer than those who received decompression only. ConclusionsThe rate of LSS surgery more than tripled in Norway from 1999 to 2013. The mean length of hospital stay was reduced from 11 to 5 days.

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Section: Introductionmentioning

confidence: 99%

The Rates of LSS Surgery in Norwegian Public Hospitals

Grøvle

Fjeld

Haugen

et al. 2019

Spine

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“…For the sciatica models which included a non-surgical comparator, models were as short as twelve months [20] [11] [21] and long as ten years [50]. Markov models were employed to perform the analyses in the longer-term horizons [16] [25] [50]. Three months was the most common choice of cycle length, with two models employing such a length [16] [24].…”

Section: Time Horizon Cycle Length and Discountingmentioning

confidence: 99%

Systematic Review of Decision Analytic Modelling in Economic Evaluations of Low Back Pain and Sciatica

Hall

Konstantinou

Lewis

et al. 2019

Appl Health Econ Health Policy

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Where a licence is displayed above, please note the terms and conditions of the licence govern your use of this document. When citing, please reference the published version. Take down policy While the University of Birmingham exercises care and attention in making items available there are rare occasions when an item has been uploaded in error or has been deemed to be commercially or otherwise sensitive.

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“…,.001 VAS leg 7.9 6 1.2 (4-10) 3.8 6 2.6 (0-9) 1.0 6 2.4 (0-7) 1.3 6 3.4 (0-9) 2.1 6 3.4 (0-9) ,.001 ODI scores 30.1 6 4.5 (21-39) 23.5 6 9.9 (10-49) 16.9 6 7.6 (8-33) 13 fixation device without removing the existing interspinous spacer. Follow-up was lost after 3 months, and the outcome of this case was classified as poor.…”

Section: Complicationsmentioning

confidence: 99%

“…10 Nonetheless, a poste-rior fixation device is still required to achieve a 3608 segmental stabilization. Several percutaneous posterior fixation devices [11][12][13][14][15] have been recently introduced that can be indicated, depending on the surgeon's preferences and the patient's demographic parameters, such as age, physical activity, gender, bone quality, adjacent segment conditions, 4 and so on. Interspinous spacers [11][12][13] have been used with varying success in the past decade.…”

Section: Introductionmentioning

confidence: 99%

“…Hence, the success of the interspinous device seems to depend on the expected postoperative biomechanical demand by the patient and consequent stress that the construct will have to support. [11][12][13] The aim of this case series was to evaluate the feasibility and preliminary clinical outcome of a full percutaneous combination of an expandable interbody cage and an interspinous spacer to stabilize the anterior and posterior columns, respectively, of the operated level of the lumbar spine ( Figure 1). We hypothesized that a full percutaneous insertion of these 2 devices through a single, small skin incision under local anesthesia would provide sufficient stability to the operated level, resulting in a corresponding successful clinical outcome, and allow a rapid recovery of the patient.…”

Section: Introductionmentioning

confidence: 99%

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Feasibility of Full Percutaneous Segmental Stabilization of the Lumbar Spine With a Combination of an Expandable Interbody Cage and an Interspinous Spacer: Preliminary Results

Morgenstern

2018

Int J Spine Surg

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Introduction:We evaluated the feasibility of a full percutaneous approach with an expandable interbody cage and an interspinous spacer for a segmental stabilization of the anterior and posterior columns of the lumbar spine, respectively, with local anesthesia.Methods: Patients were prospectively included between 2012 and 2018 in this single-center, feasibility case series. An expandable interbody cage was inserted with endoscopy-based, facet-sparing percutaneous transforaminal lumbar interbody fusion (pTLIF). An interspinous spacer was percutaneously placed through the same skin incision. Pre-and postoperative Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) outcomes at 1, 3, 6, 12, and 24 months were obtained and evaluated with the Student t test. Postoperative outcome was classified according to modified Macnab criteria.Results: A total of 16 patients were included, presenting mean preoperative scores for VAS back of 6.9 6 2.5, VAS leg 7.9 6 1.2, and ODI 30.1 6 4.5. Postoperative mean scores for VAS back of 1.9 6 2.1, VAS leg 2.1 6 3.4, and ODI 14.8 6 13.0 significantly (P , .001) decreased with a mean follow-up of 18.1 6 16.6 months (range 1-65.2). Postoperative outcome was excellent and good for 13 (81%) cases, fair for 2 (13%), and poor for 1 (6%) case with a preoperative spondylolisthesis, which required revision surgery due to persisting instability. Postoperative complications included 3 cases with transitory, ipsilateral dysesthesia and 2 cases with radiologic cage subsidence but no clinical symptoms. Median postoperative time until hospital discharge was 16 hours.Conclusion: Our preliminary results for this full percutaneous technique show a similar outcome compared to conventional surgery with a fast patient recovery and early postoperative hospital discharge, opening the way to instrumented, outpatient surgery. Endoscopic Minimally Invasive SurgeryKeywords: expandable interbody cage, interspinous spacer, percutaneous surgery, percutaneous transforaminal lumbar interbody fusion

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Understanding the value of minimally invasive procedures for the treatment of lumbar spinal stenosis: the case of interspinous spacer devices

Cited by 15 publications

References 28 publications

The Rates of LSS Surgery in Norwegian Public Hospitals

The Rates of LSS Surgery in Norwegian Public Hospitals

Systematic Review of Decision Analytic Modelling in Economic Evaluations of Low Back Pain and Sciatica

Feasibility of Full Percutaneous Segmental Stabilization of the Lumbar Spine With a Combination of an Expandable Interbody Cage and an Interspinous Spacer: Preliminary Results

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