Interspinous Process Stabilization with Rocker Via Unilateral Approach Versus X-Stop Via Bilateral Approach for Lumbar Spinal Stenosis: a Comparative Study

Overview

Journal BMC Musculoskelet Disord

Publisher Biomed Central

Specialties Orthopedics
Physiology

Date 2015 Nov 3

PMID 26522063

Citations 3

Authors

Weimin Huang

Zhengqi Chang

Jingtao Zhang

Ruoxian Song

Xiuchun Yu

Affiliations

Soon will be listed here.

Abstract

Background: Rocker is a novel interspinous process stabilization (IPS) that can be installed via unilateral approach by virtue of its unique design. This controlled study compared the clinical outcome of Rocker versus X-Stop to access the feasibility and validity of the novel IPS.

Methods: From March 2011 to September 2012, 32 patients treated with Rocker and 30 patients treated with X-Stop were enrolled in this study. The primary clinical outcome measure was Oswestry Disability Index (ODI) score. The secondary clinical outcome measure was Japanese orthopaedics association (JOA) score. Disc height index (DHI) and foraminal height index (FHI) were measured for postoperative radiographic evaluation. Implant failures were also recorded.

Results: There were 55 patients with complete data during 24 months follow-up. Among the 55 patients, 38 patients underwent IPS in combination with microdecompression. At the final follow-up, 49 patients achieved a minimal clinical important difference (≥ 8 points ODI improvement). The mean operative time was 53.6 min (range, 30 to 90 min) in Rocker group and 63.1 min (range, 30 to 100 min) in X-Stop group. The average blood loss was 111 ml (range, 50 to 400 ml) in Rocker group and 138 ml (range, 50 to 350 ml) in X-Stop group. ODI score were significantly improved from preoperative 46.8 ± 9.2 to 12.2 ± 2.6 at 24 months follow-up in the Rocker group and from preoperative 45.8 ± 9.8 to 11.8 ± 2.4 at 24 months follow-up in the X-Stop group. JOA score also improved significantly in both groups. The radiographic parameters of DHI and FHI in both groups increased immediately postoperatively, however, the improvements seemed to revert toward initial value during follow-up. Two patients in Rocker group demonstrated implant dislocation within one week postoperatively and one patient in X-Stop group demonstrated implant migration at two months postoperatively.

Conclusions: Preliminary clinical and radiographic outcome was similar between Rocker and X-Stop group. For patients of lumbar spinal stenosis with unilateral nerve root involved or mild-to-moderate central canal stenosis, Rocker offers a new alternative with less damage.

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References

Sobottke R, Schluter-Brust K, Kaulhausen T, Rollinghoff M, Joswig B, Stutzer H . Interspinous implants (X Stop, Wallis, Diam) for the treatment of LSS: is there a correlation between radiological parameters and clinical outcome?. Eur Spine J. 2009; 18(10):1494-503. PMC: 2899374. DOI: 10.1007/s00586-009-1081-y. View

Fujiwara A, Kobayashi N, Saiki K, Kitagawa T, Tamai K, Saotome K . Association of the Japanese Orthopaedic Association score with the Oswestry Disability Index, Roland-Morris Disability Questionnaire, and short-form 36. Spine (Phila Pa 1976). 2003; 28(14):1601-7. View

Ploumis A, Christodoulou P, Kapoutsis D, Gelalis I, Vraggalas V, Beris A . Surgical treatment of lumbar spinal stenosis with microdecompression and interspinous distraction device insertion. A case series. J Orthop Surg Res. 2012; 7:35. PMC: 3552687. DOI: 10.1186/1749-799X-7-35. View

Nerland U, Jakola A, Solheim O, Weber C, Rao V, Lonne G . Minimally invasive decompression versus open laminectomy for central stenosis of the lumbar spine: pragmatic comparative effectiveness study. BMJ. 2015; 350:h1603. PMC: 4381635. DOI: 10.1136/bmj.h1603. View

Gazzeri R, Galarza M, Alfieri A . Controversies about interspinous process devices in the treatment of degenerative lumbar spine diseases: past, present, and future. Biomed Res Int. 2014; 2014:975052. PMC: 4005216. DOI: 10.1155/2014/975052. View

Saberi H, Isfahani A . Higher preoperative Oswestry Disability Index is associated with better surgical outcome in upper lumbar disc herniations. Eur Spine J. 2007; 17(1):117-21. PMC: 2365528. DOI: 10.1007/s00586-007-0527-3. View

Brox J, Reikeras O, Nygaard O, Sorensen R, Indahl A, Holm I . Lumbar instrumented fusion compared with cognitive intervention and exercises in patients with chronic back pain after previous surgery for disc herniation: a prospective randomized controlled study. Pain. 2006; 122(1-2):145-55. DOI: 10.1016/j.pain.2006.01.027. View

Kim K, Park S, Kim Y . Disc height and segmental motion as risk factors for recurrent lumbar disc herniation. Spine (Phila Pa 1976). 2009; 34(24):2674-8. DOI: 10.1097/BRS.0b013e3181b4aaac. View

Barz T, Lange J, Melloh M, Staub L, Merk H, Kloting I . Histomorphometric and radiographical changes after lumbar implantation of the PEEK nonfusion interspinous device in the BB.4S rat model. Spine (Phila Pa 1976). 2012; 38(5):E263-9. DOI: 10.1097/BRS.0b013e318280c710. View

10.

Gejo R, Matsui H, Kawaguchi Y, Ishihara H, Tsuji H . Serial changes in trunk muscle performance after posterior lumbar surgery. Spine (Phila Pa 1976). 1999; 24(10):1023-8. DOI: 10.1097/00007632-199905150-00017. View

11.

Ishimoto Y, Yoshimura N, Muraki S, Yamada H, Nagata K, Hashizume H . Associations between radiographic lumbar spinal stenosis and clinical symptoms in the general population: the Wakayama Spine Study. Osteoarthritis Cartilage. 2013; 21(6):783-8. DOI: 10.1016/j.joca.2013.02.656. View

12.

Puzzilli F, Gazzeri R, Galarza M, Neroni M, Panagiotopoulos K, Bolognini A . Interspinous spacer decompression (X-STOP) for lumbar spinal stenosis and degenerative disk disease: a multicenter study with a minimum 3-year follow-up. Clin Neurol Neurosurg. 2014; 124:166-74. DOI: 10.1016/j.clineuro.2014.07.004. View

13.

Zhou D, Nong L, Du R, Gao G, Jiang Y, Xu N . Effects of interspinous spacers on lumbar degenerative disease. Exp Ther Med. 2013; 5(3):952-956. PMC: 3570253. DOI: 10.3892/etm.2013.894. View

14.

Toth J, Wang M, Estes B, Scifert J, Seim 3rd H, Turner A . Polyetheretherketone as a biomaterial for spinal applications. Biomaterials. 2005; 27(3):324-34. DOI: 10.1016/j.biomaterials.2005.07.011. View

15.

Yoshida M, Shima K, Taniguchi Y, Tamaki T, Tanaka T . Hypertrophied ligamentum flavum in lumbar spinal canal stenosis. Pathogenesis and morphologic and immunohistochemical observation. Spine (Phila Pa 1976). 1992; 17(11):1353-60. DOI: 10.1097/00007632-199211000-00015. View

16.

Ryu S, Kim I . Interspinous implant with unilateral laminotomy for bilateral decompression of degenerative lumbar spinal stenosis in elderly patients. J Korean Neurosurg Soc. 2010; 47(5):338-44. PMC: 2883053. DOI: 10.3340/jkns.2010.47.5.338. View

17.

Lonne G, Johnsen L, Rossvoll I, Andresen H, Storheim K, Zwart J . Minimally invasive decompression versus x-stop in lumbar spinal stenosis: a randomized controlled multicenter study. Spine (Phila Pa 1976). 2015; 40(2):77-85. DOI: 10.1097/BRS.0000000000000691. View

18.

Kovacs F, Urrutia G, Alarcon J . Surgery versus conservative treatment for symptomatic lumbar spinal stenosis: a systematic review of randomized controlled trials. Spine (Phila Pa 1976). 2011; 36(20):E1335-51. DOI: 10.1097/BRS.0b013e31820c97b1. View

19.

Fuchs P, Lindsey D, Hsu K, Zucherman J, Yerby S . The use of an interspinous implant in conjunction with a graded facetectomy procedure. Spine (Phila Pa 1976). 2005; 30(11):1266-72. DOI: 10.1097/01.brs.0000164152.32734.d2. View

20.

Hasegawa T, An H, Haughton V, Nowicki B . Lumbar foraminal stenosis: critical heights of the intervertebral discs and foramina. A cryomicrotome study in cadavera. J Bone Joint Surg Am. 1995; 77(1):32-8. View