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  • Spinous process distraction and fusion for degenerative lumbar stenosis: a large case series at a single institution

    Final Number:

    Hakeem Jon Shakir MD; Lindsay Lipinski MD; Joshua Meyers MD; Alex Garson; Sara Diletti; John Pollina MD; Eric P. Roger MD, BSc, FRCS(C)

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2014 Annual Meeting

    Introduction: Interspinous process distraction devices have been used in patients with lumbar stenosis and neurogenic claudication with limited success. The sp-fix (Globus Medical Inc., Audubon, PA) is a device that combines distraction with a fusion scaffold. This alteration may ameliorate the weaknesses of the early device due to added biomechanical stability.

    Methods: We report a retrospective case series of 102 consecutive patients who underwent surgery for placement of the SP-Fix device for degenerative lumbar stenosis with neurogenic claudication (with and without scoliosis and/or spondylolisthesis) and analyze our institution’s experience in patient-reported symptomatology (using the Oswestry Disability Index [ODI]), complication rate, and reoperation rate in this population.

    Results: Of the 102 patients, 44% had spondylolisthesis, 5% had scoliosis, 5% had both scoliosis and spondylolisthesis, and 46% had spinal stenosis without deformity. 8.8% of patients required reoperation (5 for spinous process fracture, 2 for infection, and 2 for failure of symptomatic improvement). Forty-eight patients completed preoperative and postoperative ODI surveys at the 3-month followup, with a mean improvement of 34%. On 91 patients in which data was available, 82% self-reported improvement in leg pain

    Conclusions: The case series suggests that patient who undergo placement of the sp-fix experience short-term symptom improvement and lower rates of reoperation than prior generation spinous process distraction devices. Long-term follow up is required to validate the use of this device as an alternative to traditional lumbar laminectomy with or without fusion as a treatment for lumbar spinal stenosis with neurogenic claudication

    Patient Care: SP-fix provides a novel, less invasive alternative for the treatment of lumbar spinal stenosis and neurogenic claudication

    Learning Objectives: By conclusion of this session, participants should 1) gain better insight into use of interspinous fixation devices 2) understand the indications for sp-fix placement 3) discuss the benefits and drawbacks of sp-fix placement when compared to traditional approaches.

    References: References 1. Alfieri A, Gazzeri R, Prell J, Scheller C, Rachinger J, Strauss C, et al: Role of lumbar interspinous distraction on the neural elements. Neurosurg Rev 35:477-484, 2012 2. Beckers L, Bekaert J: The role of lordosis. Acta Orthop Belg 57 Suppl 1:198-202, 1991 3. Buric J, Pulidori M, Sinan T, Mehraj S: DIAM device for low back pain in degenerative disc disease: 24 months follow-up. Acta Neurochir Suppl 108:177-182, 2011 4. Celik H, Derincek A, Koksal I: Surgical treatment of the spinal stenosis with an interspinous distraction device: do we really restore the foraminal height? Turk Neurosurg 22:50-54, 2012 5. Deyo RA, Martin BI, Ching A, Tosteson AN, Jarvik JG, Kreuter W, et al: Interspinous spacers compared with decompression or fusion for lumbar stenosis: complications and repeat operations in the medicare population. Spine (Phila Pa 1976) 38:865-872, 2013 6. Gunzburg R, Szpalski M: The conservative surgical treatment of lumbar spinal stenosis in the elderly. Eur Spine J 12 Suppl 2:S176-180, 2003 7. Hsu KY, Zucherman JF, Hartjen CA, Mehalic TF, Implicito DA, Martin MJ, et al: Quality of life of lumbar stenosis-treated patients in whom the X STOP interspinous device was implanted. J Neurosurg Spine 5:500-507, 2006 8. Mehra A, Baker D, Disney S, Pynsent PB: Oswestry Disability Index scoring made easy. Ann R Coll Surg Engl 90:497-499, 2008 9. Patil S, Burton M, Storey C, Glenn C, Marino A, Nanda A: Evaluation of interspinous process distraction device (X-STOP) in a representative patient cohort. World Neurosurg 80:213-217, 2013 10. Ploumis A, Christodoulou P, Kapoutsis D, Gelalis I, Vraggalas V, Beris A: Surgical treatment of lumbar spinal stenosis with microdecompression and interspinous distraction device insertion. A case series. J Orthop Surg Res 7:35, 2012 11. Schulte LM, O'Brien JR, Matteini LE, Yu WD: Change in sagittal balance with placement of an interspinous spacer. Spine (Phila Pa 1976) 36:E1302-1305, 2011 12. Siddiqui M, Nicol M, Karadimas E, Smith F, Wardlaw D: The positional magnetic resonance imaging changes in the lumbar spine following insertion of a novel interspinous process distraction device. Spine (Phila Pa 1976) 30:2677-2682, 2005 13. Verhoof OJ, Bron JL, Wapstra FH, van Royen BJ: High failure rate of the interspinous distraction device (X-Stop) for the treatment of lumbar spinal stenosis caused by degenerative spondylolisthesis. Eur Spine J 17:188-192, 2008

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