Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
Sahlgrenska University Hospital, Gothenburg, Sweden.
Eur Spine J. 2020 Jan;29(1):122-128. doi: 10.1007/s00586-019-06159-y. Epub 2019 Oct 4.
To evaluate the effect on the spinal canal at the treated and adjacent level(s), in patients treated for lumbar spinal stenosis (LSS) with percutaneous interspinous process device (IPD) Aperius™ or open decompressive surgery (ODS), using axial loading of the spine during MRI (alMRI).
Nineteen LSS patients (mean age 67 years, range 49-78) treated with IPDs in 29 spine levels and 13 LSS patients (mean age 63 years, range 46-76) operated with ODS in 22 spine levels were examined with alMRI pre- and 3 months postoperatively. Radiological effects were evaluated by measuring the dural sac cross-sectional area (DSCSA) and by morphological grading of nerve root affection.
For the IPD group, no DSCSA increase was observed at the operated level (p = 0.42); however, a decrease was observed in adjacent levels (p = 0.05). No effect was seen regarding morphological grading (operated level: p = 0.71/adjacent level: p = 0.94). For the ODS group, beneficial effects were seen for the operated level, both regarding DSCSA (p < 0.001) and for morphological grading (p < 0.0001). No changes were seen for adjacent levels (DSCSA; p = 0.47/morphological grading: p = 0.95). Postoperatively, a significant difference between the groups existed at the operated level regarding both evaluated parameters (p < 0.003).
With the spine imaged in an axial loaded position, no significant radiological effects of an IPD could be detected postoperatively at the treated level, while increased DSCSA was displayed for the ODS group. In addition, reduced DSCSA in adjacent levels was detected for the IPD group. Thus, the beneficial effects of IPD implants on the spinal canal must be questioned. These slides can be retrieved under Electronic Supplementary Material.
通过 MRI 下脊柱轴向加载（alMRI）评估接受经皮棘突间撑开器（IPD）AperiusTM 或开放性减压手术（ODS）治疗的腰椎管狭窄症（LSS）患者治疗节段和临近节段椎管的变化。
19 例接受 IPD 治疗的 LSS 患者（平均年龄 67 岁，范围 49-78 岁）共 29 个节段和 13 例接受 ODS 治疗的 LSS 患者（平均年龄 63 岁，范围 46-76 岁）共 22 个节段，分别于术前和术后 3 个月进行 alMRI 检查。通过测量硬脊膜囊横截面积（DSCSA）和神经根受累的形态学分级评估影像学变化。
在 IPD 组，未观察到手术节段的 DSCSA 增加（p=0.42）；然而，在临近节段观察到减少（p=0.05）。形态学分级未见影响（手术节段：p=0.71/临近节段：p=0.94）。对于 ODS 组，手术节段的 DSCSA（p<0.001）和形态学分级（p<0.0001）均有获益。临近节段未见变化（DSCSA；p=0.47/形态学分级：p=0.95）。术后，两组在评估参数上均存在手术节段的显著差异（p<0.003）。
在轴向加载状态下对脊柱成像，术后在治疗节段未发现 IPD 的明显放射学影响，而 ODS 组的 DSCSA 增加。此外，在 IPD 组还观察到临近节段的 DSCSA 减少。因此，必须对 IPD 植入物对椎管的有益影响提出质疑。这些幻灯片可以在电子补充材料中检索到。
