ASSESSING SPINOPLASTY IN RELATION TO SINGLE AND DOUBLE INTERSPINOUS SPACER APPLICATIONS: A STRATEGY FOR AUGMENTING POSTERIOR ARCH STABILITY AND PREVENTING SURGICAL FAILURE

L. Manfrè¹ , M. Frigerio² , M. Bonetti²

¹ Department of Radiology, IOM Mediterranean Oncology Institute, Viagrande, Sicily, Italy
² Department of Neuroradiology, Clinical Institute, “Città di Brescia”, Brescia, Italy

Correspondence to:

Journal of Orthopedics 2022 Sep-Dec; 14(3): 90-96
https://doi.org/10.69149/orthopedics/2022v14iss3_1

Received: 6 October 2022 Accepted: 23 November 2022

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Abstract

Lumbar spinal canal stenosis (LSCS) is among the most prevalent degenerative conditions in older individuals. Treatment failure can occur, typically associated with bone remodeling or fractures of the spinous processes. Polymethylmethacrylate (PMMA) augmentation of the posterior arch (spinoplasty, SP) has recently been suggested for cases of neoplastic involvement. This investigation assessed the effectiveness of SP as a preventive therapy prior to the placement of an interspinous spacer (IS). Additionally, we explored the possibility of addressing patients who had previously received IS implants that subsequently failed by introducing a second spacer at the same level alongside accessory SP. Between January 2009 and August 2021, 593 patients with LSCS were treated with CT-guided percutaneous IS implantation in our facility. Starting from January 2011, all patients diagnosed with osteoporosis underwent prophylactic SP before the spacer’s insertion. Furthermore, in cases of re-stenosis attributed to bone remodeling and/or fractures, a second similar device was placed after strengthening the spinous processes with PMMA, aimed at reopening the stenotic spinal canal. Among patients who received prophylactic treatment before spacer placement, no re-stenosis was noted during the follow-up period of three to twelve months. Patients who underwent secondary spacer implantation at the same level following posterior arch augmentation once again reported alleviation of symptoms, with no further bone remodeling detected during follow-up evaluations. In conclusion, prophylactic SP prevents the failure of individual spacers due to bone remodeling/fractures and facilitates failure repair through the introduction of a second spacer at the same level.

Keywords: lumbar canal stenosis, prophylaxis, spacer, spine