Top

Archives of Orthopaedic and Trauma Surgery

Published in:

01-11-2010 | Orthopaedic Surgery

Soft stabilization with interspinous artificial ligament for mildly unstable lumbar spinal stenosis: a multicenter comparison

Authors: Sang-Ho Lee, Manuel Enes, Thomas Hoogland

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 11/2010

Abstract

Introduction

In an attempt to fill a gap between simple decompression alone and fusion in the spectrum of surgical treatment for degenerative lumbar spinal stenosis (DLSS), the authors sought to demonstrate the efficacy and reproducibility of soft stabilization with interspinous artificial ligament after microsurgical fenestration to prevent post-decompression segmental instability for mildly unstable DLSS.

Materials and methods

Clinical outcomes from 556 patients treated with soft stabilization with artificial ligament following microdecompression for mildly unstable DLSS from March 1998 to June 2006 were retrospectively obtained from three institutions in three countries. Outcomes were measured at a mean of 48.9 months after surgery using MacNab criteria. Peri- and postoperative complications and revision surgery cases were also analyzed.

Results

Follow-up was achieved in 391 (70.3%) of the 556 patients. Clinical outcomes were excellent in 43.7%, good in 36.7%, fair in 12.2%, and poor in 7.4% of the patients. The overall clinical success rate was 80.4%. No major complications except postoperative hematoma and wound infection (6/391 cases, 1.5%) were observed, and few revision surgeries (2.3%) were done during follow-up.

Conclusion

We found favorable and reproducible results with soft stabilization with artificial ligament after microdecompression for mildly unstable DLSS from three institutions in three countries. Soft stabilization with artificial ligament may be concluded to represent an effective prevention of increased post-decompression instability with reliable reproducibility for mildly unstable DLSS in carefully selected patients.

Asano S, Kaneda K, Tadano S, Uhmehara S (1992) The mechanical properties of the human L4–L5 functional spinal unit during cyclic loading. Spine 17:1343–1352CrossRefPubMed

Atlas SJ, Deyo RA, Keller RB, Chapin AM, Patrick DL, Long JM, DE Singer (1996) The Maine Lumbar Spine Study, Part III. 1-year outcomes of surgical and nonsurgical management of lumbar spinal stenosis. Spine 21(15):1787–1794CrossRefPubMed

Bono CM, Vaccaro AR (2007) Interspinous process devices in the lumbar spine. J Spinal Disord Tech 20(3):255–261CrossRefPubMed

Briggs AM, Greig AM, Wark JD, Fazzalari NL, Bennell KL (2004) A review of anatomical and mechanical factors affecting vertebral body integrity. Int J Med Sci 1(3):170–180PubMed

Christie SD, Song JK, Fessler RG (2005) Dynamic interspinous process technology. Spine 30(16 Suppl):S73–S78CrossRefPubMed

Cornefjord M, Byröd G, Brisby H, Rydevik B (2000) A long-term (4- to 12-year) follow-up study of surgical treatment of lumbar spinal stenosis. Eur Spine J 9(6):563–570CrossRefPubMed

diPierro CG, Helm GA, Shaffrey CI, Chadduck JB, Henson SL, Malik JM, Szabo TA, Simmons NE, Jane JA (1996) Treatment of lumbar spinal stenosis by extensive unilateral decompression and contralateral autologous bone fusion: operative technique and results. J Neurosurg 84(2):166–173CrossRefPubMed

Fassio B, Cohen R, Beguin C, Jucopilla N (1991) Treatment of degenerative lumbar spinal instability L4–L5 by interspinous ligamentoplasty. Rachis 3:465–474

Garner MD, Wolfe SJ, Kuslich SD (2002) Development and preclinical testing of a new tension-band device for the spine: the Loop system. Eur Spine J 11(Suppl 2):S186–S191PubMed

10.

Hioki A, Miyamoto K, Kodama H, Hosoe H, Nishimoto H, Sakaeda H, Shimizu K (2005) Two-level posterior lumbar interbody fusion for degenerative disc disease: improved clinical outcome with restoration of lumbar lordosis. Spine J 5(6):600–607CrossRefPubMed

11.

Iguchi T, Kurihara A, Nakayama J, Sato K, Kurosaka M, Yamasaki K (2000) Minimum 10-year outcome of decompressive laminectomy for degenerative lumbar spinal stenosis. Spine 25(14):1754–1759CrossRefPubMed

12.

Kaech DL, Woodtli MD (2006) Interspinous U fixation in spinal stenosis and lumbar disc surgery. European Association of Neurosurgical Societies. Grand-Duche de Luxembourg, Feb 2006

13.

Katz JN, Lipson SJ, Chang LC, Levine SA, Fossel AH, Liang MH (1996) Seven- to 10-year outcome of decompressive surgery for degenerative lumbar spinal stenosis. Spine 21(1):92–98CrossRefPubMed

14.

Kim DH, Albert TJ (2007) Interspinous process spacers. J Am Acad Orthop Surg 15(4):200–207PubMed

15.

Lee J, Hida K, Seki T, Iwasaki Y, Minoru A (2004) An interspinous process distractor (X STOP) for lumbar spinal stenosis in elderly patients: preliminary experiences in 10 consecutive cases. J Spinal Disord Tech 17(1):72–77CrossRefPubMed

16.

Lee SH, Lee IM, Sung KH, Sung YS, Kim JS (1997) Comparison of posterior interbody fusion, posterolateral fusion, and interspinous ligamentoplasty for degenerative lumbar instability. J Neurosurg 86:424A (abstract)

17.

Lee SH, Kim JS (2002) Comparison of ligamentoplasty to rigid fixation for degenerative lumbar instability. J Minim Invasive Spinal Tech 2(1):10–14

18.

Legaye J (2005) Unfavorable influence of the dynamic neutralization system on sagittal balance of the spine. Rev Chir Orthop Reparatrice Appar Mot 91(6):542–550 (article in French)PubMed

19.

Macnab I (1971) Negative disc exploration: an analysis of the causes of nerve-root involvement in sixty-eight patients. J Bone Joint Surg (Am) 53:891–903

20.

Malmivaara A, Slätis P, Heliövaara M et al (2007) Surgical or nonoperative treatment for lumbar spinal stenosis? A randomized controlled trial. Spine 32(1):1–8CrossRefPubMed

21.

Mochida J, Toh E, Suzuki K, Chiba M, Arima T (1997) An innovative method using the Leeds–Keio artificial ligament in the unstable spine. Orthopedics 20(1):17–23PubMed

22.

Mulholland RC, Sengupta DK (2002) Rationale, principles and experimental evaluation of the concept of soft stabilization. Eur Spine J 11(Suppl 2):S198–S205PubMed

23.

Onda A, Otani K, Konno S, Kikuchi S (2006) Mid-term and long-term follow-up data after placement of the Graf stabilization system for lumbar degenerative disorders. J Neurosurg Spine 5(1):26–32CrossRefPubMed

24.

Papp T, Porter RW, Aspden RM, Shepperd JAN (1997) An in vitro study of the biomechanical effects of flexible stabilization on the lumbar spine. Spine 22:151–155CrossRefPubMed

25.

Postacchini F (1989) Lumbar spinal stenosis. Springer, New York

26.

Raffo CS, Lauerman WC (2006) Predicting morbidity and mortality of lumbar spine arthrodesis in patients in their ninth decade. Spine 31(1):99–103CrossRefPubMed

27.

Schiavone AM, Pasquale G (2003) The use of disc assistance prostheses (Diam) in degenerative lumbar pathology: Indications, technique, and results. Ital J Spinal Disord 3:213–220

28.

Sénégas J (2002) Mechanical supplementation by non-rigid fixation in degenerative intervertebral lumbar segments: the Wallis system. Eur Spine J 11(Suppl 2):S164–S169PubMed

29.

Sénégas J, Etchevers JP, Vital JM, Baulny D, Grenier F (1988) Le recalibrage du canal lombaire, alternative a la laminectomie dans le traitement des stenoses du canal lombarie. Rev Chir Orthop 74:15–22PubMed

30.

Sengupta DK, Truumees E, Patel CK, Kazmierczak C, Hughes B, Elders G, Herkowitz HN (2006) Outcome of local bone versus autogenous iliac crest bone graft in the instrumented posterolateral fusion of the lumbar spine. Spine 31(9):985–991CrossRefPubMed

31.

Sharma M, Langrana NA, Rodriguez J (1995) Role of ligaments and facets in lumbar spinal instability. Spine 20:887–900CrossRefPubMed

32.

Shepherd DE, Leahy JC, Mathias KJ, Wilkinson SJ, Hukins DW (2000) Spinous process strength. Spine 25(3):319–323CrossRefPubMed

33.

Shim CS, Lee SH, Park SH, Whang JH (2007) Soft stabilization with an artificial intervertebral ligament in grade I degenerative spondylolisthesis: comparison with instrumented posterior lumbar interbody fusion. Spine Arthroplasty Soc J 1(3):118–124

34.

Talwar V, Lindsey DP, Fredrick A, Hsu KY, Zucherman JF, Yerby SA (2006) Insertion loads of the X STOP interspinous process distraction system designed to treat neurogenic intermittent claudication. Eur Spine J 15(6):908–912CrossRefPubMed

35.

Taylor J, Pupin P, Delajoux S, Palmer S (2007) Device for intervertebral assisted motion: technique and initial results. Neurosurg Focus 22(1):E6CrossRefPubMed

36.

Vaccaro AR, Garfin SR (1995) Internal fixation (pedicle screw fixation) for fusion of the lumbar spine. Spine 20:157S–165SCrossRefPubMed

37.

Villavicencio AT, Burneikiene S, Bulsara KR, Thramann JJ (2006) Perioperative complications in transforaminal lumbar interbody fusion versus anterior–posterior reconstruction for lumbar disc degeneration and instability. J Spinal Disord Tech 19(2):92–97CrossRefPubMed

38.

Voydeville G, Diop A, Lavaste F, Girard F, Hardy P (2000) Experimental lumbar instability and artificial ligament. Eur J Orthop Surg Traumatol 10:167–176CrossRef

39.

Wang MY, Green BA, Shah S, Vanni S, Levi AD (2003) Complications associated with lumbar stenosis surgery in patients older than 75 years of age. Neurosurg Focus 14(2):e7CrossRefPubMed

40.

Wilby MJ, Seeley H, Laing RJ (2006) Laminectomy for lumbar canal stenosis: a safe and effective treatment. Br J Neurosurg 20(6):391–395CrossRefPubMed

41.

Zucherman JF, Hsu KY, Hartjen CA, Mehalic TF, Implicito DA, Martin MJ, Johnson DR 2nd, Skidmore GA, Vessa PP, Dwyer JW, Puccio ST, Cauthen JC, Ozuna RM (2005) A multicenter, prospective, randomized trial evaluating the X STOP interspinous process decompression system for the treatment of neurogenic intermittent claudication: two-year follow-up results. Spine 30(12):1351–1358CrossRefPubMed

Title: Soft stabilization with interspinous artificial ligament for mildly unstable lumbar spinal stenosis: a multicenter comparison
Authors: Sang-Ho Lee
Manuel Enes
Thomas Hoogland
Publication date: 01-11-2010
Publisher: Springer-Verlag
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 11/2010
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-009-1031-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Soft stabilization with interspinous artificial ligament for mildly unstable lumbar spinal stenosis: a multicenter comparison

Abstract

Introduction

Materials and methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Materials and methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 11/2010

Endoscopic plantar fasciotomy versus extracorporeal shock wave therapy for treatment of chronic plantar fasciitis

Letter to editor

Treatment of 103 displaced tibial diaphyseal fractures with a radiolucent unilateral external fixator

Growth plate fractures of the distal tibia: is CT imaging necessary?

Percutaneous cervical nucleoplasty and percutaneous cervical discectomy treatments of the contained cervical disc herniation

Early history of operative treatment of fractures