Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA.
Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA.
Curr Pain Headache Rep. 2020 Feb 18;24(4):13. doi: 10.1007/s11916-020-0845-2.
Symptomatic lumbar spinal stenosis (LSS) is a condition affecting a growing number of individuals resulting in significant disability and pain. Traditionally, treatment options have consisted of conservative measures such as physical therapy, medication management, epidural injections and percutaneous adhesiolysis, or surgery. There exists a treatment gap for patients failing conservative measures who are not candidates for surgery. Minimally invasive lumbar decompression (MILD®) and interspinous process device (IPD) with Superion® represent minimally invasive novel treatment options that may help fill this gap in management. We performed a literature review to separately evaluate these procedures and assess the effectiveness and safety.
The available evidence for MILD and Superion has been continuously debated. Overall, it is considered that while the procedures are safe, there is only modest evidence for effectiveness. For both procedures, we have reviewed 13 studies. Based on the available evidence, MILD and Superion are safe and modestly effective minimally invasive procedures for patients with symptomatic LSS. It is our recommendation that these procedures may be incorporated as part of the continuum of treatment options for patients meeting clinical criteria.
有症状的腰椎管狭窄症（LSS）是一种影响越来越多的个体的疾病，导致严重的残疾和疼痛。传统上，治疗方案包括保守治疗，如物理治疗、药物管理、硬膜外注射和经皮粘连松解术，或手术。对于那些不能手术的保守治疗失败的患者，存在治疗空白。微创腰椎减压术（MILD®）和 Superion®棘突间装置是微创的新治疗选择，可能有助于填补这一管理空白。我们进行了文献回顾，分别评估这些程序并评估其有效性和安全性。
MILD 和 Superion 的现有证据一直存在争议。总的来说，虽然这些程序是安全的，但有效性的证据只有适度。对于这两种程序，我们都审查了 13 项研究。根据现有证据，MILD 和 Superion 是安全的，对于有症状的 LSS 患者来说是一种适度有效的微创程序。我们建议将这些程序纳入符合临床标准的患者治疗方案的连续体中。
