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用于治疗中度退行性腰椎管狭窄症的Superion(®)椎间融合器:一项随机对照试验的三年长期结果

Superion(®) InterSpinous Spacer for treatment of moderate degenerative lumbar spinal stenosis: durable three-year results of a randomized controlled trial.

作者信息

Patel Vikas V, Nunley Pierce D, Whang Peter G, Haley Thomas R, Bradley W Daniel, Davis Raphael P, Block Jon E, Geisler Fred H

机构信息

The Spine Center, University of Colorado Hospital, Denver, CO, USA.

Spine Institute of Louisiana, Shreveport, LA, USA.

出版信息

J Pain Res. 2015 Oct 3;8:657-62. doi: 10.2147/JPR.S92633. eCollection 2015.

Abstract

PURPOSE

This report provides the 3-year clinical outcomes from the randomized, controlled US Food and Drug Administration Investigational Device Exemption trial of the Superion(®) for the treatment of moderate degenerative lumbar spinal stenosis.

PATIENTS AND METHODS

The Superion(®) was evaluated in the treatment of subjects aged 45 years or older suffering from symptoms of intermittent neurogenic claudication, secondary to a confirmed diagnosis of moderate degenerative lumbar spinal stenosis at one or two contiguous levels from L1 to L5. Patients were treated between June 2008 and December 2011 at 31 investigational sites. Three hundred ninety-one subjects were included in the randomized study group consisting of 190 Superion(®) and 201 X-STOP(®) control subjects. The primary composite endpoint was individual patient success based on four components: improvement in two of three domains of the Zurich Claudication Questionnaire, no reoperations at the index level, no major implant/procedure-related complications, and no clinically significant confounding treatments.

RESULTS

At 3 years, the proportion of subjects achieving the primary composite endpoint was greater for Superion(®) (63/120, 52.5%) than for X-STOP(®) (49/129, 38.0%) (P=0.023) and the corresponding success rates exceeded 80% for each of the individual components of the primary endpoint in the Superion(®) group (range: 81%-91%). Improvements in back and leg pain severity as well as back- and disease-specific functional outcomes were also maintained through 36 months.

CONCLUSION

The 3-year outcomes from this randomized controlled trial demonstrate durable clinical improvement consistently across all clinical outcomes for the Superion(®) in the treatment of patients with moderate degenerative lumbar spinal stenosis.

摘要

目的

本报告提供了美国食品药品监督管理局对Superion®治疗中度退行性腰椎管狭窄症的随机对照研究器械豁免试验的3年临床结果。

患者与方法

对年龄在45岁及以上、因确诊为L1至L5一个或两个连续节段的中度退行性腰椎管狭窄症而出现间歇性神经源性跛行症状的受试者进行Superion®治疗评估。2008年6月至2011年12月期间,在31个研究地点对患者进行了治疗。随机研究组纳入了391名受试者,其中190名使用Superion®,201名使用X-STOP®作为对照。主要复合终点是基于四个组成部分的个体患者成功:苏黎世跛行问卷三个领域中的两个领域有所改善、索引节段未再次手术、无重大植入物/手术相关并发症以及无临床显著的混杂治疗。

结果

3年时,Superion®组达到主要复合终点的受试者比例(63/120,52.5%)高于X-STOP®组(49/129,38.0%)(P = 0.023),并且Superion®组主要终点的各个组成部分的相应成功率均超过80%(范围:81%-91%)。背部和腿部疼痛严重程度以及背部和疾病特异性功能结局的改善在36个月内也得以维持。

结论

这项随机对照试验的3年结果表明,Superion®在治疗中度退行性腰椎管狭窄症患者的所有临床结局中均持续显示出持久的临床改善。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/58b3/4599047/774d5a5a1d9d/jpr-8-657Fig1.jpg

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