[Interspinous spacers--technique of Coflex™ implantation].

OBJECTIVE: This surgical procedure addresses the reduction of spinal stenoses as a short-term result. In the long run, prevention of recurrent narrowing of the spinal canal and the development of sciatic pain is the goal by taking load from the facet joint and indirect extension of the neuroforamina. This is achieved by interspinous distraction of the described spacer. In addition, this implant leads to a dynamic limitation of a spinal motion segment. INDICATIONS: Spinal stenosis in conjunction with moderate spondylarthrosis without signs of spondylolisthesis (> Meyerding 1°). Other indications are revisions after nucleotomies and primary nucleotomies in cases of massive disk hernia. CONTRAINDICATIONS: Segmental instabilities (degeneration or spondylolisthesis), advanced spondylarthrosis, dysraphia of the vertebral arc, scoliosis at the segment to treat, significant osteoporosis, tumor, infection. SURGICAL TECHNIQUE: Interlaminar decompression and implantation of an interspinous spacer. POSTOPERATIVE MANAGEMENT: Mobilization not before 2 h postoperatively. Wound drain removal after approximately 24 h. In case of treatment of more than one segment as as well as in cases of revision and obesity, a lumbar orthesis for 6 weeks is recommended. Physiotherapy to improve active lumbar stabilization especially by isometric exercises. Lifting of heavy loads (> 5 kg) and extensive flexion should be avoided.
RESULTS: So far, inconsistent results in currently available retrospective studies. Comparable short-term results in prospective studies of sole decompression without implantation of an interspinous spacer. Prospective randomized comparative studies are not yet available.