a new monolaterally inserted interspinous device in the mini- invasive surgical treatment of lumbar...
TRANSCRIPT
A New Monolaterally Inserted Interspinous Device in the Mini-Invasive Surgical Treatment of Lumbar Disc Herniation
associated with Lumbar Canal Stenosis
M. Fricia, M. Passanisi, F. Inserra, F. Barone, G. Distefano, P. Seminara, F. Ventura
U.O.C. Neurosurgery
Director: Prof. Fausto Ventura
A. O. “Cannizzaro” Catania - Italy
XIV World Congress of WFNS
Boston, MA August 30 – September 4, 2009
INTRODUCTION
Interspinous devices are a new mini-invasive method of surgical
treatment for several lumbar spine disorders
The indications for positioning of these devices are currently
lumbar spinal stenosis, grade 1 spondylolisthesis, axial-load induced
back pain, facet syndrome, degenerative and/or iatrogenic (post-
discectomy) disc syndrome, unloading of disc adjacent to a lumbar
fusion procedure, primary or secondary
INTRODUCTION
Medically non-responders patients with stable or worsening
diseases and evident lumbar disc herniation with associated just
slight local or above- and down-located stenosis are surgically
treated just by removing disc herniation
Post-operative results depending on selected patients and
different surgical techniques are, when successful, stable but
burdened by recurrence or prevalent lumbar stenosis syndrome. In
these cases we describe our preliminary experience with a new
interspinous device, monolaterally-inserted and easy to use after
microdiscectomy
METHODS
During one-year time 27 patients (Group B) were so treated and
compared with other 31 only microdiscectomy-treated patients
(Group A)
The treated levels were L3/L4, L4/L5, L5/S1
Clinical assessment was done before and after surgery by
Oswestry Disability Index (ODI) and Visual Analogous Scale (VAS)
This new interspinous devices features of a Spacer of Peek (polyetheretherketone) and titanium hinge
TECHNIQUE
TECHNIQUE
TECHNIQUE
POST MICRODISCECTOMY DILATATE
SIZE IMPLANT
Microdiscectomy + interspinous device L4/L5
Microdiscectomy + interspinous device L4/L5 – L5/S1
RESULTS
Follow-up one year
Oswestry Score Group A = 59,8% (before surgery) → 13,9%
(after surgery)
Oswestry Score Group B = 58,3% (before surgery) → 8,7% (after
surgery)
VAS score no statistically significant differences in the both group
RESULTS
Preliminary our data suggest a faster improvement in device-
treated patients with no disc herniation recurrence
Evaluation of levels did not reveal any statistically significant
differences
No perioperative/postoperative complications
CONCLUSIONS
Although our data are not statistically significant, due to
the small number of patients, we may predict a better
clinical result with this particular device in selected
patients presenting such associated conditions