Introduction: Insertion of an interspinous devices has became a common procedure for the treatment of different clinical pictures of degenerative spinal disease. We present our experience with patients treated with interspinous devices because affected by “claudicatio neurogena” or/and lumbar disc herniation where the interspinous system has been inserted following microdiscectomy.
Methods: This study included patients (n 200) with neurogenic intermittent claudicatio (NIC) secondary to lumbar spinal stenosis (LSS) (group 1) and patients (n 150) with lumbar disc herniation (group 2) in whom the interspinous device has been implanted following radicular decompression in a period spanning 6 years. The latter have been compared with an homogenous group of patients (n. 150) in whom no interspinous system has been implanted following microdiscectomy (group 3). We observed clinical and neuroradiological findings pre-operatively and 3, 6, 12 months and every year post-operatively using dedicated questionnaires (Zurich Claudication Questionnaire, SF-36, ODI) and X-ray imaging.
Results: Six year following surgical treatment 85% of patients of group 1 presented a very good improvement of symptoms and 90% of patients referred satisfaction for surgery. Only 2% of the cases needed re-operation to change the implant. In 1 case the device was removed and in 2 cases we observed recurrence of symptoms and a different surgical strategy has been performed. Overall patients of group 2 presented significant less lumbar disc recurrences compared with group 3 (p<0.05) and better clinical outcome when compared with the same group (p<0.01).
Conclusions: According to our features, no significant complications were associated with such a kind of surgery. In particular, interspinous systems showed significant and clinically meaningful improvements in pain and disability for up to 6 years. Furthermore, interspinous devices have shown better clinical outcome and less lumbar disc recurrences when associated with standard microdiscectomy. These data, however, need further studies and a longer follow-up.
Patient Care: Our experience support a possible role of a minimally invasive approach for lumbar spinal stenosis by means interspinous devices and following microdiscectomy
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Discuss about the efficacy of interspinous devices in lumbar spinal stenosis; 2)Discuss about the efficacy of interspinous devices following microdiscectomy.