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The Interspinous Spacer: A New Posterior Dynamic Stabilization Concept for Prevention of Adjacent Segment Disease

DOI: 10.1155/2013/637362

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Introduction. Posterior Dynamic stabilization using the interspinous spacer device is a known to be used as an alternative to rigid fusion in neurogenic claudication patients in the absence of macro instability. Actually, it plays an important in the management of adjacent segment disease in previously fused lumbar spine. Materials and Method. We report our experience with posterior dynamic stabilization using an interspinous spacer. 134 cases performed in our institution between September 2008 and August 2012 with different lumbar spine pathologies. The ages of our patients were between 40 and 72 years, with a mean age of 57 years. After almost 4 years of follow up in our patient and comparing their outcome to our previous serious we found that in some case the interspinous distracter has an important role not only in the treatment of adjacent segment disease but also in its prevention. Results and Discussion. Clinical improvement was noted in ISD-treated patients, with high satisfaction rate. At first, radicular pain improves with more than 3/10 reduction of the mean score on visual analog scale (VAS). In addition, disability score as well as disc height and lordotic angle showed major improvement at 3 to 6 months post operatively. And, no adjacent segment disease was reported in the patient operated with interspinous spacer. Conclusion. The interspinous spacer is safe and efficient modality to be used not only as a treatment of adjacent segment disease but also as a preventive measure in patients necessitating rigid fusion. 1. Introduction Spinal disorders are among the most common health complaints affecting a large portion of the population in developed and developing countries [1]. Spinal disorders can be treated medically at first and the majority of patients will respond to the latter, whereas others will need surgical treatment for their spinal disease. And though, degenerative disease of the spinal cord became a serious problem with the aging of the population and its management is in continuous evolution. Spinal stenosis manifested by back or radicular pain and nonresponding to conservative management or evolution to neurogenic claudication necessitates surgical procedure. The management of this pathology changed over time and in case decompressive surgery was not sufficient or the spinal segments degenerated later on, a rigid fusion was used. Rigid fusion was efficient and provided better outcome compared to decompression alone, but it could not resolve the problem of disc degeneration without evident radicular compression [2]. And,


[1]  C. S. Chen, C. K. Cheng, C. L. Liu, and W. H. Lo, “Stress analysis of the disc adjacent to interbody fusion in lumbar spine,” Medical Engineering and Physics, vol. 23, no. 7, pp. 483–491, 2001.
[2]  M. Kanayama, T. Hashimoto, K. Shigenobu et al., “Adjacent-segment morbidity after Graf ligamentoplasty compared with posterolateral lumbar fusion,” Journal of Neurosurgery, vol. 95, no. 1, pp. 5–10, 2001.
[3]  S. D. Christie, J. K. Song, and R. G. Fessler, “Dynamic interspinous process technology,” Spine, vol. 30, no. 16, pp. S73–S78, 2005.
[4]  D. Adelt, J. Samani, W.-K. Kim, et al., “Coflex Interspinous Stabilisation: clinical and Radiographic results from an international multicenter retrospective study,” Paradigm Spine Journal, no. 1, pp. 1–4, 2007.
[5]  D. L. Kaech, C. Fernandez, and P. Haninec, “Preliminary experience with the interspinous U device,” Rachis, vol. 13, pp. 303–304, 2001.
[6]  D. L. Kaech, C. Fernandez, D. Lombardi-Weber, et al., “The interspinous U: a new restabilization device for the lumbar spine,” Spinal Restabilization Procedures, vol. 30, pp. 355–362, 2000.
[7]  D. L. Kaech and J. R. Jinkins, “The interspinous “U”: a new restabilization device for the lumbar spine Spinal Restabilization Procedures,” Elsevier Science B.V., pp. 355–362, 2002.
[8]  C. Bowers, A. Amini, A. T. Dailey, and M. H. Schmidt, “Dynamic interspinous process stabilization: review of complications associated with the X-Stop device,” Neurosurgical Focus, vol. 28, no. 6, p. E8, 2010.
[9]  D. K. Resnick, T. F. Choudhri, A. T. Dailey et al., “Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 5: correlation between radiographic and functional outcome,” Journal of Neurosurgery. Spine, vol. 2, no. 6, pp. 658–661, 2005.
[10]  M. N. Kumar, A. Baklanov, and D. Chopin, “Correlation between sagittal plane changes and adjacent segment degeneration following lumbar spine fusion,” European Spine Journal, vol. 10, no. 4, pp. 314–319, 2001.
[11]  J. S. Mehta, S. Kochhar, and I. J. Harding, “A slip above a slip: retrolisthesis of the motion segment above a spondylolytic spondylolysthesis,” European Spine Journal, vol. 21, no. 11, pp. 2128–2133, 2012.
[12]  F. Pellisé, A. Hernández, X. Vidal, J. Minguell, C. Martínez, and C. Villanueva, “Radiologic assessment of all unfused lumbar segments 7.5 years after instrumented posterior spinal fusion,” Spine, vol. 32, no. 5, pp. 574–579, 2007.
[13]  A. Nachanakian, A. El Helou, and M. Alaywan, Posterior Dynamic Stabilization: The Interspinous spacer, Low Back Pain Pathogenesis and Treatment, Edited by Y. Sakai, InTech, 2012.
[14]  S.-W. Yu, C.-Y. Yen, C.-H. Wu, F.-C. Kao, Y.-H. Kao, and Y.-K. Tu, “Radiographic and clinical results of posterior dynamic stabilization for the treatment of multisegment degenerative disc disease with a minimum follow-up of 3 years,” Archives of Orthopaedic and Trauma Surgery, vol. 132, pp. 583–589, 2012.
[15]  T. Cansever, E. Civelek, S. Kabatas, C. Y?lmaz, H. Caner, and M. N. Altin?rs, “Dysfunctional segmental motion treated with dynamic stabilization in the lumbar spine,” World Neurosurgery, vol. 75, no. 5-6, pp. 743–749, 2011.
[16]  F. Heuer, H. Schmidt, W. K?fer, N. Graf, and H.-J. Wilke, “Posterior motion preserving implants evaluated by means of intervertebral disc bulging and annular fiber strains,” Clinical Biomechanics, vol. 27, pp. 218–225, 2012.
[17]  K. E. Swanson, D. P. Lindsey, K. Y. Hsu, J. F. Zucherman, and S. A. Yerby, “The effects of an interspinous implant on intervertebral disc pressures,” Spine, vol. 28, no. 1, pp. 26–32, 2003.
[18]  Y. H. Jia and P. F. Sun, “Preliminary evaluation of posterior dynamic lumbar stabilization in lumbar degenerative disease in Chinese patients,” Chinese Medical Journal, vol. 125, no. 2, pp. 253–256, 2012.
[19]  W. Schmoelz, S. Erhart, S. Unger, and C. Alexander, “Disch: biomechanical evaluation of a posterior non-fusion instrumentation of the lumbar spine,” European Spine Journal, vol. 21, pp. 939–945, 2012.
[20]  B. Cakir, B. Ulmar, H. Koepp, K. Huch, W. Puhl, and M. Richter, “Posterior dynamic stabiliziation as on alternative for instrumented fusion in the treatment of degenerative lumbar instability with spinal stenosis,” Zeitschrift fur Orthopadie und Ihre Grenzgebiete, vol. 141, no. 4, pp. 418–424, 2003.


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