Chin Kingsley R, Pencle Fabio J R, Benny Amala, Seale Jason A
Less Exposure Surgery Specialists Institute (LESS Institute), Hollywood, FL, USA.
Herbert Wertheim College of Medicine at Florida International University, Hollywood, FL, USA.
J Spine Surg. 2020 Sep;6(3):549-554. doi: 10.21037/jss-20-547.
Lumbar spinal stenosis is treated with decompression directly such as laminectomies and indirectly with an interspinous device through distraction and extension block. Interspinous devices (IPD) have also been used as an adjunct to spinal fusion. However, the design for IPD to treat spinal stenosis does not fixate the spine while the design for spinal fusion is designed to fixate the spine. There is a paucity of data on a single device that has been used for both fusion and stenosis. Authors aim to demonstrate the long-term outcomes of interspinous fixation at L4-5 for degenerative spinal stenosis.
We evaluated patients with spinal stenosis and degenerative disc disease who were treated with open decompression and distraction of the spinous processes at L4-L5 using an interspinous device. All patients complained of lower back pain and neurogenic claudication. This is a retrospective review of prospectively collected data (level 3) under an IRB approved study cohort. The charts of patient undergoing lumbar decompression with Interspinous Distraction, Fixation using InSpan device (INSPAN LLC) in an outpatient setting were reviewed with over a 5-year follow-up period.
122 surgical cases of lumbar decompression with interspinous fixation, spanning between the timeframe of September 2011 to October 2016. A total of 56 patients had instrumentation at L4-L5. Total female population was 46%. The median age of the patients included in the population was 50.9±10.7 years with a median BMI of 24.8±11.4 kg/m. Two-year VAS and ODI showed significant improvement from 8.1±1.2 to 1.5±1.1 and 42.9±14.3 to 14.8±5.1. All surgeries were completed in less than one hour. There was a total of 1 revision case with removal of INSPAN and open hemilaminectomy decompression.
Long term results demonstrated improved outcomes in patients who underwent Interspinous distraction decompression in an ambulatory surgery center using the INSPAN IPD at L4-L5 for Degenerative Spinal Stenosis. There was one revision converted to hemilaminectomy. There were no complications or blood transfusions.
腰椎管狭窄症的治疗方法包括直接减压，如椎板切除术，以及通过撑开和延长阻滞使用棘突间装置进行间接减压。棘突间装置（IPD）也被用作脊柱融合术的辅助手段。然而，用于治疗椎管狭窄的IPD设计并不固定脊柱，而脊柱融合术的设计旨在固定脊柱。关于一种同时用于融合和狭窄治疗的单一装置的数据很少。作者旨在证明L4 - 5节段棘突间固定治疗退变性腰椎管狭窄症的长期疗效。
我们评估了接受L4 - L5节段棘突间开放减压和撑开治疗的腰椎管狭窄症和退变性椎间盘疾病患者。所有患者均主诉下腰痛和神经源性间歇性跛行。这是一项对前瞻性收集数据的回顾性研究（3级），研究队列经机构审查委员会（IRB）批准。对在门诊环境中使用InSpan装置（INSPAN LLC）进行腰椎减压、棘突间撑开固定的患者病历进行了超过5年的随访审查。
2011年9月至2016年10月期间，共122例接受棘突间固定腰椎减压手术。共有56例患者在L4 - L5节段进行了器械植入。女性患者总数占46%。纳入人群的患者中位年龄为50.9±10.7岁，中位体重指数为24.8±11.4kg/m²。两年的视觉模拟评分（VAS）和腰椎功能障碍指数（ODI）显示从8.1±1.2显著改善至1.5±1.1，以及从42.9±14.3显著改善至14.8±5.1。所有手术均在不到一小时内完成。共有1例翻修病例，移除了InSpan装置并进行了开放半椎板切除术减压。
长期结果表明，在门诊手术中心使用InSpan IPD对L4 - L5节段退变性腰椎管狭窄症患者进行棘突间撑开减压，患者预后得到改善。有1例翻修病例转为半椎板切除术。无并发症或输血情况。
