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Lumbar Interspinous Process Fixation and Fusion with Stand-Alone Interlaminar Lumbar Instrumented Fusion Implant in Patients with Degenerative Spondylolisthesis Undergoing Decompression for Spinal Stenosis.

Postacchini F, Postacchini R, Menchetti PP, Sessa P, Paolino M, Cinotti G - Asian Spine J (2016)

Bottom Line: The mean NRS score for back and leg pain decreased by 64% and 80%, respectively.The mean ODI score was decreased by 52%.Stand-alone ILIF with interspinous bone grafting promotes vertebral fusion in most patients with lumbar stenosis and unstable Grade I DS undergoing BL or BDUL.

View Article: PubMed Central - PubMed

Affiliation: Department of Saimlal, Section of Orthopedic Surgery, Clinica Ortopedica, Università Sapienza, Rome, Italy.

ABSTRACT

Study design: Prospective cohort study.

Purpose: To assess the ability of a stand-alone lumbar interspinous implant (interspinous/interlaminar lumbar instrumented fusion, ILIF) associated with bone grafting to promote posterior spine fusion in degenerative spondylolisthesis (DS) with vertebral instability.

Overview of literature: A few studies, using bilateral laminotomy (BL) or bilateral decompression by unilateral laminotomy (BDUL), found satisfactory results in stenotic patients with decompression alone, but others reported increased olisthesis, or subsequent need for fusion in DS with or without dynamic instability.

Methods: Twenty-five patients with Grade I DS, leg pain and chronic low back pain underwent BL or BDUL and ILIF implant. Olisthesis was 13% to 21%. Follow-up evaluations were performed at 4 to 12 months up to 25 to 44 months (mean, 34.4). Outcome measures were numerical rating scale (NRS) for back and leg pain, Oswestry disability index (ODI) and short-form 36 health survey (SF-36) of body pain and function.

Results: Fusion occurred in 21 patients (84%). None had increased olisthesis or instability postoperatively. Four types of fusion were identified. In Type I, the posterior part of the spinous processes were fused. In Type II, fusion extended to the base of the processes. In Type III, bone was present also around the polyetheretherketone plate of ILIF. In Type IV, even the facet joints were fused. The mean NRS score for back and leg pain decreased by 64% and 80%, respectively. The mean ODI score was decreased by 52%. SF-36 bodily pain and physical function mean scores increased by 53% and 58%, respectively. Computed tomography revealed failed fusion in four patients, all of whom still had vertebral instability postoperatively.

Conclusions: Stand-alone ILIF with interspinous bone grafting promotes vertebral fusion in most patients with lumbar stenosis and unstable Grade I DS undergoing BL or BDUL.

No MeSH data available.


Related in: MedlinePlus

A 63-year-old male with L4–L5 degenerative spondylolisthesis. (A, B, C) Sagittal computed tomography scans showing supraspinous and interspinous bone fusion (white arrows). Bone is present also between the base of spinous processes (black arrow).
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Figure 4: A 63-year-old male with L4–L5 degenerative spondylolisthesis. (A, B, C) Sagittal computed tomography scans showing supraspinous and interspinous bone fusion (white arrows). Bone is present also between the base of spinous processes (black arrow).

Mentions: The 21 patients with fusion showed no increase in olisthesis. Of these patients, at baseline seven had mild and 13 had moderate dynamic translational instability, and one showed severe translational and moderate angular instability. At the final follow-up, no patients showed a change in translational or angular motion. On CT scans, four types of bony fusion were identified (Table 3). In Type I, the bone joined the posterior part of the spinous processes (Fig. 3). In Type II, it also joined the base of the spinous processes (Fig. 4). In Type III, it was present also around the PEEK plate. In Type IV, fusion of even the facet joints had occurred (Fig. 5). Interlaminar fusion was not detected in any case. Significant differences were found for all outcome measures between the mean scores at baseline and those at last follow-up (Table 4). The mean NRS score decreased by 64.5% for low back pain and 80.4% for leg pain. The mean ODI score diminished by 52.6%. The mean SF-36 bodily pain and physical function scores increased by 53.7% and 58.9%, respectively. The mean scores of all measures did not change significantly between the 12-month and last follow-up.


Lumbar Interspinous Process Fixation and Fusion with Stand-Alone Interlaminar Lumbar Instrumented Fusion Implant in Patients with Degenerative Spondylolisthesis Undergoing Decompression for Spinal Stenosis.

Postacchini F, Postacchini R, Menchetti PP, Sessa P, Paolino M, Cinotti G - Asian Spine J (2016)

A 63-year-old male with L4–L5 degenerative spondylolisthesis. (A, B, C) Sagittal computed tomography scans showing supraspinous and interspinous bone fusion (white arrows). Bone is present also between the base of spinous processes (black arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4764537&req=5

Figure 4: A 63-year-old male with L4–L5 degenerative spondylolisthesis. (A, B, C) Sagittal computed tomography scans showing supraspinous and interspinous bone fusion (white arrows). Bone is present also between the base of spinous processes (black arrow).
Mentions: The 21 patients with fusion showed no increase in olisthesis. Of these patients, at baseline seven had mild and 13 had moderate dynamic translational instability, and one showed severe translational and moderate angular instability. At the final follow-up, no patients showed a change in translational or angular motion. On CT scans, four types of bony fusion were identified (Table 3). In Type I, the bone joined the posterior part of the spinous processes (Fig. 3). In Type II, it also joined the base of the spinous processes (Fig. 4). In Type III, it was present also around the PEEK plate. In Type IV, fusion of even the facet joints had occurred (Fig. 5). Interlaminar fusion was not detected in any case. Significant differences were found for all outcome measures between the mean scores at baseline and those at last follow-up (Table 4). The mean NRS score decreased by 64.5% for low back pain and 80.4% for leg pain. The mean ODI score diminished by 52.6%. The mean SF-36 bodily pain and physical function scores increased by 53.7% and 58.9%, respectively. The mean scores of all measures did not change significantly between the 12-month and last follow-up.

Bottom Line: The mean NRS score for back and leg pain decreased by 64% and 80%, respectively.The mean ODI score was decreased by 52%.Stand-alone ILIF with interspinous bone grafting promotes vertebral fusion in most patients with lumbar stenosis and unstable Grade I DS undergoing BL or BDUL.

View Article: PubMed Central - PubMed

Affiliation: Department of Saimlal, Section of Orthopedic Surgery, Clinica Ortopedica, Università Sapienza, Rome, Italy.

ABSTRACT

Study design: Prospective cohort study.

Purpose: To assess the ability of a stand-alone lumbar interspinous implant (interspinous/interlaminar lumbar instrumented fusion, ILIF) associated with bone grafting to promote posterior spine fusion in degenerative spondylolisthesis (DS) with vertebral instability.

Overview of literature: A few studies, using bilateral laminotomy (BL) or bilateral decompression by unilateral laminotomy (BDUL), found satisfactory results in stenotic patients with decompression alone, but others reported increased olisthesis, or subsequent need for fusion in DS with or without dynamic instability.

Methods: Twenty-five patients with Grade I DS, leg pain and chronic low back pain underwent BL or BDUL and ILIF implant. Olisthesis was 13% to 21%. Follow-up evaluations were performed at 4 to 12 months up to 25 to 44 months (mean, 34.4). Outcome measures were numerical rating scale (NRS) for back and leg pain, Oswestry disability index (ODI) and short-form 36 health survey (SF-36) of body pain and function.

Results: Fusion occurred in 21 patients (84%). None had increased olisthesis or instability postoperatively. Four types of fusion were identified. In Type I, the posterior part of the spinous processes were fused. In Type II, fusion extended to the base of the processes. In Type III, bone was present also around the polyetheretherketone plate of ILIF. In Type IV, even the facet joints were fused. The mean NRS score for back and leg pain decreased by 64% and 80%, respectively. The mean ODI score was decreased by 52%. SF-36 bodily pain and physical function mean scores increased by 53% and 58%, respectively. Computed tomography revealed failed fusion in four patients, all of whom still had vertebral instability postoperatively.

Conclusions: Stand-alone ILIF with interspinous bone grafting promotes vertebral fusion in most patients with lumbar stenosis and unstable Grade I DS undergoing BL or BDUL.

No MeSH data available.


Related in: MedlinePlus