Abstract
The clinical outcome of patients with symptomatic lumbar spinal stenosis (LSS) was assessed during a follow-up period of 2 years after X-Stop implantation. The X-Stop is the most commonly used interspinous distraction device in patients with neurogenic intermittent claudication due to LSS. Between 2003 and 2007, more than 1,000 patients were examined in our centre with symptoms of intermittent claudication due to spinal stenosis. Between February 2003 and June 2007, in 175 of these patients an X-Stop device was implanted in one or two levels. Patients were clinically evaluated regularly during a follow-up period of up to 4 years using the VAS (leg pain) score and the Oswestry disability index. The mean VAS (leg pain) score in these 175 patients was reduced from 61.2% preoperatively to 39.0% at the first clincal follow-up examination at 6 weeks postoperatively. The mean VAS score at 24 months postoperatively was 39.0%. Oswestry score was 32.6% preoperatively, 22.7% at 6 weeks, and 20.3% at 24 months postoperatively on average. In eight out of the implanted 175 patients, the X-Stop had to be removed and a microsurgical decompression had to be performed because of unsatisfactory effect of the interspinous distraction device. Our single-centre results indicate not only a satisfactory short-term, but also a good long-term effect during a follow-up period of 2 years. Functional MRI examinations provide helpful, positional-dependent preoperative information. More than any radiological feature, the typical clinical picture of positional-dependent claudication with a relief of symptoms during flexion is the most important factor for appropriate patient selection. The interspinous device does not replace microsurgical decompression in patients with massive stenosis and continuous claudication, but offers a save, effective and less invasive alternative in selected patients with spinal stenosis. Concerning the operative technique, a minimally invasive implantation with preservation of the interspinous ligament is appropriate. Functional (upright-) MRI examinations were able to demonstrate the positional-dependent stenosis. If available, fMRI represents the most helpful radiologic examination in assessing the outcome of interspinous spacer implantation.
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References
Cavusoglu H, Kaya RA, Türkmenoglu ON, Tuncer C, Colak I, Aydin Y (2007) Midterm outcome after unilateral approach for bilateral decompression of lumbar spine stenosis: 5-year prospective study. Eur Spine J 16(12):2133–2142
Cavusoglu H, Türkmenoglu O, Kaya RA, Tuncer C, Colak I, Sahni Y, Aydin Y (2007) Efficacy of unilateral laminectomy for bilateral decompression in lumbar spinal stenosis. Turk Neurosurg 17(2):100–108
Chung SS, Lee CS, Kim SH (2000) Effect of low back posture on the morphology of the spinal canal. Skeletal Radiol 29:217–223
Dunlop RB, Adams MA, Hutton WC (1984) Disc space narrowing and the lumbar facet joints. J Bone Joint Surg Br 66:706–710
Johnsson KE, Rosen I, Uden A (1992) The natural course of lumbar spinal stenosis. Clin Orthop Relat Res 279:82–86
Katz JN, Lipson SJ, Chang LC, Levine SA, Fossel AH, Liang MH (1996) Seven to 10-year outocme after decompressive surgery for degenerative lumbar spinal stenosis. Spine 21(1):92–98
Kondrashov DG, Hannibal M, Hsu KY, Zucherman JF (2006) Interspinous process decompression with the XSTOP® device for lumbar spinal stenosis: a 4-year follow-up study. J Spinal Disord Tech 19:323–327
Lindsay DP, Swanson KE, Fuchs P, Hsu KY, Zucherman JF, Yerby S (2003) The effects of an interspinous implant on the kinematics of the instrumented and adjacent levels in the lumbar spine. Spine 28(19):2192–2197
Richards JC, Majumdar S, Lindsay DP, Beaupre GS, Yerby SA (2005) The treatment mechanism of an interspinous process implant for lumbar neurogenic intermittent claudication. Spine 30(7):744–749
Shonauer C, Boccheti A, Barbagallo A, Albanese V, Moraci A (2004) Positioning on the surgical table. Eur Spine J 13(S1):S50–S55
Siddiqui M, Nicol M, Karadimas E, Smith F, Wardlaw D (2005) The positional magnetic resonance imaging changes in the lumbar spine following insertion of a novel interspinous process distraction device. Spine 30(23):2677–2682
Simons P (2006) Dekompression bei spinaler claudicatio intermittens. Orthopaedie Rheuma 4:50–53 Ger
Swanson KE, Lindsay DP, Hsu KY, Zucherman JF, Yerby S (2003) The effects of an interspinous implant on intervertebral disc pressures. Spine 28(1):26–32
Turner JA, Ersek M, Herron L (1992) Surgery for lumbar spinal stenosis. Attempted meta-analysis of the literature. Spine 17:1–8
Wiseman CM, Lindsey DP, Frederick AD, Yerby SA (2005) The effect of an interspinous process implant on facet loading during extension. Spine 30(8):903–907
Zamani AA, Moriatry T, Hsu L et al (1998) Functional MRI of the lumbar spine in erect postition in a superconducting open-configurator MR system: preliminary results. J Magn Reson Imaging 8:1329–1333
Zucherman JF, Hsu KY, Hartjen CA, Mehalic TF, Implicito DA, Martin MJ et al (2004) A prospective randomized multi-center study for the treatment of lumbar spinal stenosis with the X STOP interspinous implant: 1 year results. Eur Spine J 13:22–31
Zucherman JF, Hsu KY, Hartjen CA, Mehalic TF, Implicito DA, Martin MJ et al (2005) Multicenter, prospective randomized trial evaluating the XSTOP® interspinous process decompression system for the treatment of neurogenic intermittent claudication. Spine 30(12):1351–1358
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Dr. Pascal Niggemann, upright MRI Centre Cologne for multi-position MRI scans.
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Kuchta, J., Sobottke, R., Eysel, P. et al. Two-year results of interspinous spacer (X-Stop) implantation in 175 patients with neurologic intermittent claudication due to lumbar spinal stenosis. Eur Spine J 18, 823–829 (2009). https://doi.org/10.1007/s00586-009-0967-z
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DOI: https://doi.org/10.1007/s00586-009-0967-z