Siepe Christoph J, Heider Franziska, Beisse Rudolf, Mayer H Michael, Korge Andreas
Wirbelsäulenzentrum, Schön Klinik München Harlaching, München, Germany.
Oper Orthop Traumatol. 2010 Nov;22(5-6):524-35. doi: 10.1007/s00064-010-9042-5.
Indirect decompression of the spinal canal and the neuroforamina by means of interspinous process distraction and limitation of extension movements. Reduction of forces acting on the posterior joint structures of a functional spinal unit (posterior anulus, facet joints, intervertebral discs).
Primary indication: Spinal claudication with improvement of the clinical symptomatology upon taking an inclined position. Secondary indication: Low back pain in the presence of accompanying retrolisthesis. Hyperlordosis Facet joint complaints Annulus lesions with high intensity zones (HIZ) M. Baastrup ("kissing spine"). Adjacent segment preservation (e.g. prophylaxis of recurrent disc herniation after discectomy or topping-off following previous fusion).
Spinal instabilities which prohibit a solid fixation of the implant (e.g. spondylolysis, isthmus fractures, condition following previous (hemi-) laminectomy) Degenerative spondylolisthesis ffl 1st degree. Severe structural narrowing of the spinal canal. Absent dynamic aspect without improvement upon inclination, segmental ankylosis.
Positioning of the patient in an inclined position. Approximately 4 cm median skin incision, bilateral access with preservation of the supraspinous ligament. Perforation of the interspinous ligament. Following interspinous distraction the adequate size implant is established. Insertion of the interspinous process distraction device (IPD) unit and fixation of the mobile wing unit from the contralateral side. Medial positioning and solid fixation of the implant by connecting the two implant units.
Lumbar orthosis (optional), otherwise no further support required. Daily living activities immediately after the operation. Physiotherapeutic exercises (optional). Low impact sporting activities from 2nd week after operation, intense/ high impact sporting activities from 6 months postoperatively.
Previous studies have reported satisfactory results for interspinous distraction devices for the treatment of dynamic spinal canal stenosis. However, the majority of these previously published studies are based on data with only shortterm follow-up or small patient numbers. In particular, the results of interspinous spacers for the treatment of different indications have not been evaluated separately. Complications and long-term results still need to be established.
通过棘突间撑开和限制伸展运动间接减压椎管和神经孔。减轻作用于功能性脊柱单元后关节结构（后纵环、小关节、椎间盘）的力量。
主要适应症：脊柱间歇性跛行，采取倾斜姿势后临床症状改善。次要适应症：伴有椎体后移的下腰痛。腰椎前凸增加；小关节疼痛；存在高强度区（HIZ）的椎间盘病变；巴斯楚普氏病（“亲吻脊柱”）。保留相邻节段（例如，椎间盘切除术后预防复发性椎间盘突出症或先前融合术后补充融合）。
脊柱不稳定，禁止牢固固定植入物（例如椎弓根峡部裂、峡部骨折、先前（半）椎板切除术后情况）；退行性椎体滑脱1度。椎管严重结构狭窄。无动态变化且倾斜后无改善，节段性强直。
患者取倾斜位。沿中线做约4cm皮肤切口，双侧入路并保留棘上韧带。穿透棘间韧带。棘突间撑开后确定合适尺寸的植入物。插入棘突间撑开装置（IPD）单元，并从对侧固定活动翼单元。通过连接两个植入物单元将植入物向内侧定位并牢固固定。
佩戴腰部矫形器（可选），否则无需进一步支撑。术后立即进行日常生活活动。物理治疗锻炼（可选）。术后第2周开始进行低强度体育活动，术后6个月开始进行高强度/高冲击力体育活动。
先前的研究报告了棘突间撑开装置治疗动力性椎管狭窄的满意结果。然而，这些先前发表的研究大多基于短期随访数据或少量患者。特别是，棘突间间隔器治疗不同适应症的结果尚未单独评估。并发症和长期结果仍有待确定。
