Schroeder Josh E, Kaplan Leon, Barzilay Shimon, Barzilay Yair
Spine Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
Evid Based Spine Care J. 2011 May;2(2):19-24. doi: 10.1055/s-0030-1267101.
A retrospective cohort of 68 patients who underwent insertion of the DIAM (Medtronic Sofamor Danek, Switzerland) interspinous device (ISD) during 2006-2008 at one medical center.
To assess the short- and intermediate-term outcomes and complications associated with ISD.
Evaluation of files and all patients who underwent insertion of a DIAM ISD was performed. Patients walking distances and pain (visual analog scale score) were compared with data gathered before surgery. Outcome and all complications related to ISD have been identified and analyzed.
All 68 patients were available for follow-up. Mean follow-up was 34 months (23-52 months). The average age was 57 (±13) years. Walking distance increased by 890% and patient's pain score improved by 3.27 points on visual analog scale. Twenty-one (32%) of the 68 patients had perioperative or late complications. Nine complications (75%) were unrelated to ISD and included 5 dura tears, 3 wound-related complications, and 1 transient ischemic attack. Spinous process fractures occurred in 5 cases, leading to revision in 2 cases. In total, 7 of the patients required revision surgery. These patients were older, with an average age of 69 years.
The outcome of patients who had an implantation of the DIAM ISD is good. In this cohort, 6% developed recurrent claudication symptoms in the second postoperative year. In an older population, the combination of softer bone and rigid stenosis increase the risk of spinous process fracture, resulting in failure and leading to revision surgery. Other solutions should be sought for these patients. [Table: see text] The definiton of the different classes of evidence is available on page 55.
对2006年至2008年期间在一家医疗中心接受DIAM（美敦力索法莫·丹尼克公司，瑞士）棘突间装置（ISD）植入术的68例患者进行回顾性队列研究。
评估与ISD相关的短期和中期结局及并发症。
对所有接受DIAM ISD植入术的患者病历进行评估。将患者的步行距离和疼痛程度（视觉模拟评分）与术前收集的数据进行比较。确定并分析与ISD相关的结局和所有并发症。
所有68例患者均获随访。平均随访时间为34个月（23 - 52个月）。平均年龄为57（±13）岁。步行距离增加了890%，患者的视觉模拟评分疼痛程度改善了3.27分。68例患者中有21例（32%）发生围手术期或晚期并发症。9例并发症（75%）与ISD无关，包括5例硬脊膜撕裂、3例伤口相关并发症和1例短暂性脑缺血发作。发生棘突骨折5例，其中2例需要翻修手术。总共有7例患者需要翻修手术。这些患者年龄较大，平均年龄为69岁。
植入DIAM ISD的患者结局良好。在该队列中，6%的患者在术后第二年出现复发性跛行症状。在老年人群中，骨质较软和狭窄僵硬的共同作用增加了棘突骨折的风险，导致手术失败并需要翻修手术。对于这些患者应寻求其他解决方案。[表格：见正文]不同证据类别的定义见第55页。
