Siewe Jan, Selbeck Max, Koy Timmo, Röllinghoff Marc, Eysel Peer, Zarghooni Kourosh, Oppermann Johannes, Herren Christian, Sobottke Rolf
Department of Orthopaedic and Trauma Surgery, University of Cologne, Cologne, Germany.
Department of Orthopaedic and Trauma Surgery, University of Halle/Saale, Halle/Saale, Germany.
J Neurol Surg A Cent Eur Neurosurg. 2015 Jan;76(1):1-7. doi: 10.1055/s-0034-1382779. Epub 2014 Oct 7.
Interspinous process decompression devices (IPD) allow a minimally invasive treatment of lumbar spinal stenosis (LSS), but their use is discussed highly controversial. Several level I studies suggest that IPD implantation is a viable alternative for both conservative treatment and decompression, but clear indications and contraindications are still missing. This study was designed to explore the perspectives and limitations of IPDs and to evaluate the role of these devices in general.
The study is based on a questionnaire sent to all hospitals registered in the German Hospital Address Register 2010 with an orthopedic, neurosurgerical, or spine surgery department (n = 1,321). The questionnaire was reviewed by experienced spine surgeons and statisticians, and included both single-response, close-ended, and multiple-response open-ended questions.
We received 329 (24.9%) entirely analyzable questionnaires. A total of 164 respondents (49.8%) stated that IPDs are a treatment option for LSS, and 135 of the 164 respondents (82.3%) use them. Poor clinical experience (60%) and lack of evidence (53.9%) are the main reasons cited for not using IPDs. We detected a high negative correlation between the size of the hospital, the number of outpatients and inpatients treated for LSS and other spine pathologies, and the use of IPDs (p = 0.001). Most respondents prefer the combination of open decompression and IPD (64.4%; n = 87). A total of 9.6% (n = 13) of the users favor IPD implantation as a stand-alone procedure. Overall, 25.9% n = 35 use both options. Most surgeons aim to relieve the facet joints (87.7%) and to stabilize a preexisting instability (75.4%). They recommend IPDs in the segments L2-L3 (77%), L3-L4 (98.5%), and L4-l5 (99.3%) and consider that IPD implanation also could be done at the L5-S1 segment (40.1%). Overall, 64.4% (n = 87) of the users recommend limiting IPD implantation to two segments. Infection (96.3%), fracture (94.8%), isthmic spondylolisthesis (77%), degenerative spondylolisthesis (higher than Meyerding I [57%]), lumbar spine scoliosis (48.1%), and osteoporosis (50.4%) are seen as contraindications for IPD.
No clear consensus exists among spine surgeons concerning the use of IPD for LSS treatment. The study showed that hospital-related parameters also influence decision making for or against the use of IPDs. However, despite the lack of evidence, the indications and contraindications which had been identified in the present study might contribute to improved outcomes after IPD implantation or at least prevent harm to patients.
棘突间减压装置（IPD）可用于腰椎管狭窄症（LSS）的微创治疗，但其应用存在高度争议。多项一级研究表明，IPD植入术对于保守治疗和减压而言是一种可行的替代方法，但仍缺乏明确的适应证和禁忌证。本研究旨在探讨IPD的应用前景和局限性，并总体评估这些装置的作用。
本研究基于一份问卷，该问卷发送给了2010年德国医院地址登记册中所有设有骨科、神经外科或脊柱外科科室的医院（n = 1321）。问卷由经验丰富的脊柱外科医生和统计学家进行审核，包括单项回答、封闭式和多项回答开放式问题。
我们共收到329份（24.9%）可完全分析的问卷。共有164名受访者（49.8%）表示IPD是LSS的一种治疗选择，其中164名受访者中有135名（82.3%）使用IPD。未使用IPD的主要原因是临床经验不足（60%）和缺乏证据（53.9%）。我们发现医院规模、LSS及其他脊柱疾病的门诊和住院患者数量与IPD的使用之间存在高度负相关（p = 0.001）。大多数受访者倾向于开放减压与IPD联合使用（64.4%；n = 87）。共有9.6%（n = 13）的使用者倾向于将IPD植入作为独立手术。总体而言，25.9%（n = 35）的使用者两种方法都采用。大多数外科医生旨在缓解小关节（87.7%）并稳定已有的不稳定情况（75.4%）。他们推荐在L2 - L3节段（77%）、L3 - L4节段（98.5%）和L4 - L5节段（99.3%）使用IPD，并认为IPD植入也可在L5 - S1节段进行（40.1%）。总体而言，64.4%（n = 87）的使用者建议将IPD植入限制在两个节段。感染（96.3%）、骨折（94.8%）、峡部裂性腰椎滑脱（77%）、退行性腰椎滑脱（高于迈耶丁I级[57%]）、腰椎脊柱侧弯（48.1%）和骨质疏松症（50.4%）被视为IPD的禁忌证。
脊柱外科医生对于IPD用于LSS治疗尚未达成明确共识。研究表明，与医院相关的参数也会影响IPD使用与否的决策。然而，尽管缺乏证据，但本研究中确定的适应证和禁忌证可能有助于改善IPD植入后的疗效，或至少防止对患者造成伤害。
