Kevin Phan1, Prashanth J Rao2, Jonathon R Ball3, Ralph J Mobbs1. 1. NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, Australia;; University of New South Wales (UNSW), Sydney, Australia; 2. NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, Australia;; University of New South Wales (UNSW), Sydney, Australia;; Royal North Shore Hospital (RNSH), Sydney, Australia. 3. Royal North Shore Hospital (RNSH), Sydney, Australia.
Abstract
BACKGROUND: Interspinous spacers are used in selected patients for the treatment of lumbar spinal stenosis. The uses of interspinous devices are still debated, with reports of significantly higher reoperation rates and unfavourable cost-effectiveness compared to traditional decompression techniques. METHODS: Six electronic databases were searched from their date of inception to December 2015. Relevant studies were identified using specific eligibility criteria and data was extracted and analyzed based on predefined primary and secondary endpoints. RESULTS: Eleven comparative studies were obtained for qualitative and quantitative assessment, data extraction and analysis. There was no significant difference in VAS back pain, leg pain or ODI scores for standalone interspinous process device (IPD) vs. bony decompression. However, standalone IPD was associated with lower surgical complications (4% vs. 8.7%, P=0.03) but higher long-term reoperation rates (23.7% vs. 8.5%, P<0.00001). IPD as an adjunct to decompression had comparable patient-reported scores, complications and reoperation rates to decompression alone. CONCLUSIONS: Current evidence indicates no superiority for mid- to long-term patient-reported outcomes for IPD compared with traditional bony decompression, with lesser surgical complications but at the risk of significantly higher reoperation rates and costs.
BACKGROUND: Interspinous spacers are used in selected patients for the treatment of lumbar spinal stenosis. The uses of interspinous devices are still debated, with reports of significantly higher reoperation rates and unfavourable cost-effectiveness compared to traditional decompression techniques. METHODS: Six electronic databases were searched from their date of inception to December 2015. Relevant studies were identified using specific eligibility criteria and data was extracted and analyzed based on predefined primary and secondary endpoints. RESULTS: Eleven comparative studies were obtained for qualitative and quantitative assessment, data extraction and analysis. There was no significant difference in VAS back pain, leg pain or ODI scores for standalone interspinous process device (IPD) vs. bony decompression. However, standalone IPD was associated with lower surgical complications (4% vs. 8.7%, P=0.03) but higher long-term reoperation rates (23.7% vs. 8.5%, P<0.00001). IPD as an adjunct to decompression had comparable patient-reported scores, complications and reoperation rates to decompression alone. CONCLUSIONS: Current evidence indicates no superiority for mid- to long-term patient-reported outcomes for IPD compared with traditional bony decompression, with lesser surgical complications but at the risk of significantly higher reoperation rates and costs.
Authors: Wouter A Moojen; Mark P Arts; Wilco C H Jacobs; Erik W van Zwet; M Elske van den Akker-van Marle; Bart W Koes; Carmen Lam Vleggeert-Lankamp; Wilco C Peul Journal: Eur Spine J Date: 2015-01-14 Impact factor: 3.134
Authors: James F Zucherman; Ken Y Hsu; Charles A Hartjen; Thomas F Mehalic; Dante A Implicito; Michael J Martin; Donald R Johnson; Grant A Skidmore; Paul P Vessa; James W Dwyer; Stephen T Puccio; Joseph C Cauthen; Richard M Ozuna Journal: Spine (Phila Pa 1976) Date: 2005-06-15 Impact factor: 3.468
Authors: M Elske van den Akker-van Marle; Wouter A Moojen; Mark P Arts; Carmen L A M Vleggeert-Lankamp; Wilco C Peul Journal: Spine J Date: 2014-10-23 Impact factor: 4.166
Authors: Carolina Ramírez Martínez; Kai-Uwe Lewandrowski; José Gabriel Rugeles Ortíz; Gabriel Oswaldo Alonso Cuéllar; Jorge Felipe Ramírez León Journal: Int J Spine Surg Date: 2020-10-29
Authors: Joseph L Laratta; Hemant Reddy; Joseph M Lombardi; Jamal N Shillingford; Comron Saifi; Charla R Fischer; Ronald A Lehman; Lawrence G Lenke Journal: Global Spine J Date: 2017-09-14