a new monolaterally inserted interspinous device in the mini- invasive surgical treatment of lumbar...

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