THE APPLICATION OF INTERSPINOUS SPACERS IN CONJUNCTION WITH SPINOPLASTY TREATMENT: INSIGHTS FROM OUR EXPERIENCE

L. Manfrè¹ , A.E. De Vivo¹, H. Al Qatami², A. Own³, F. Ventura⁴, K. Zhou⁵, R.V. Chandra⁶ , J.A. Hirsch⁷ , M. Frigerio⁸ , M. Bonetti⁸

¹ Department of Radiology, IOM Mediterranean Oncology Institute, Viagrande, Sicily, Italy
² Neuroradiology, Hamad General Hospital. Academic Health Sytem, Doha, Qatar
³ Department of Neuroradiology, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
⁴ Department of Radiology, IOM Mediterranean Oncology Institute, Viagrande, Sicily, Italy
⁵ Interventional Neuroradiology, Monash Health, Clayton, Victoria, Australia
⁶ Department of Interventional Neuroradiology, Monash Health, Clayton, Victoria, Australia
⁷ NeuroInterventional Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
⁸ Department of Neuroradiology, Clinical Institute, “Città di Brescia”, Brescia, Italy

Correspondence to:

Journal of Orthopedics 2024 May-August; 16(2): 49-56

Received: 26 April 2024 Accepted: 23 May 2024

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Abstract

Lumbar spinal canal stenosis and foraminal stenosis of the lumbar spine are widespread degenerative conditions that may lead to neurogenic claudication, significantly affecting patients’ functionality and overall quality of life. Recently, percutaneous interspinous devices (PIDs) have surfaced as a minimally invasive substitute treatment option. This study outlines a twenty-year experience at a singular center with PIDs and evaluates the adjunctive use of spinous process augmentation (spinoplasty) to enhance clinical outcomes. The cases included were collected up to 2023. A retrospective cohort study was executed involving 900 consecutive patients who sought treatment at a specialized spine clinic, with 788 ultimately undergoing intervention. Inclusion criteria encompassed substantial stenosis, failure of conservative management approaches, and electromyographic verification. Within this cohort, 288 individuals received a PID alone, while 500 underwent concurrent polymethyl methacrylate (PMMA) augmentation of the adjoining spinous processes. Follow-up evaluations were conducted at 3 and 12 months utilizing the Zurich Claudication Questionnaire (ZCQ) and the Oswestry Disability Index (ODI). Results: both groups demonstrated considerable improvements in ZCQ scores (from 3.2 to 1.3) and ODI metrics (from 32 to 21), in addition to high levels of patient satisfaction (mean score of 1.7). The incidence of symptom recurrence due to complications was significantly lower in the cohort receiving spinous process augmentation compared to the group treated exclusively with PIDs (<1% vs 10,76%). The results of this investigation underscore the effectiveness of percutaneous interspinous devices in the management of lumbar spinal stenosis. Furthermore, the findings indicate that the combination of spinous process augmentation with PID treatment reduces the likelihood of symptom recurrence.

Keywords: LSCS, LSFS, lumbar foraminal stenosis, lumbar spinal canal stenosis, neurogenic claudication, spine, spinoplasty, spinous process augmentation