15-year Survivorship Analysis of an Interspinous Device in Surgery for Single-level Lumbar Disc Herniation

Overview

Journal BMC Musculoskelet Disord

Publisher Biomed Central

Specialties Orthopedics
Physiology

Date 2021 Dec 10

PMID 34886816

Citations 2

Authors

Yoon Joo Cho

Jong-Beom Park

Dong-Gune Chang

Hong Jin Kim

Affiliations

Soon will be listed here.

Abstract

Background: Interspinous devices have been introduced as alternatives to decompression or fusion in surgery for degenerative lumbar diseases. This study aimed to investigate 15-year survivorship and risk factors for reoperation of a Device for Intervertebral Assisted Motion (DIAM) in surgery for 1-level lumbar disc herniation (LDH).

Methods: A total of 94 patients (54 men and 40 women) underwent discectomy and DIAM implantation for 1-level LDH, with a mean follow-up of 12.9 years (range, 6.3-15.3 years). The mean age was 46.2 years (range, 21-65 years). Sixty-two patients underwent DIAM implantation for L4-5, 27 for L5-6, and 5 for L3-4. Reoperations due to any reason associated with DIAM implantation level or adjacent levels were defined as failure and used as the end point of determining survivorship.

Results: During the 15-year follow-up, 8 patients (4 men and 4 women) underwent reoperation due to recurrence of LDH at the DIAM implantation level, a reoperation rate of 8.5%. The mean time to reoperation was 6.5 years (range, 0.8-13.9 years). Kaplan-Meier analysis showed a cumulative survival rate of the DIAM implantation of 97% at 5 years, 93% at 10 years, and 92% at 15 years after surgery; the cumulative reoperation rate of the DIAM implantation was 3% at 5 years, 7% at 10 years, and 8% at 15 years after surgery. Mean survival time was predicted to be 14.5 years (95% CI, 13.97-15.07). The log-rank test and Cox proportional hazard model showed that age, sex, and location did not significantly affect the reoperation rate of DIAM implantation.

Conclusions: Our results showed that DIAM implantation significantly decreased reoperation rate for LDH in the 15-year survivorship analysis. We suggest that DIAM implantation could be considered a useful intermediate step procedure for LDH surgery. To the best of our knowledge, this is the longest follow-up study in which surgical outcomes of interspinous device surgery were reported.

Citing Articles

Comparative Analysis of Early and Long-Term Outcomes of Patients with Degenerative Lumbar Spine Disease Using the DIAM Stabilizer and Standard Rehabilitation Program: A Preliminary Prospective Randomized Controlled Trial with 1-Year Follow-Up.

Druszcz A, Mis M, Paprocka-Borowicz M, Rosinczuk J, Czapiga B Healthcare (Basel). 2023; 11(22).

PMID: 37998448 PMC: 10671364. DOI: 10.3390/healthcare11222956.

Evaluating 5-year outcomes of interlaminar devices as an adjunct to decompression for symptomatic lumbar spinal stenosis.

Kumar N, Thomas A, Rajoo M, Lee S, Kumar L, Shen L Eur Spine J. 2023; 32(4):1367-1374.

PMID: 36840820 DOI: 10.1007/s00586-023-07610-x.

References

Errico T, Kamerlink J, Quirno M, Samani J, Chomiak R . Survivorship of coflex Interlaminar-Interspinous Implant. SAS J. 2015; 3(2):59-67. PMC: 4365593. DOI: 10.1016/SASJ-2008-0027-RR. View

Wu A, Zhou Y, Li Q, Wu X, Jin Y, Luo P . Interspinous spacer versus traditional decompressive surgery for lumbar spinal stenosis: a systematic review and meta-analysis. PLoS One. 2014; 9(5):e97142. PMC: 4014612. DOI: 10.1371/journal.pone.0097142. View

Kim M, Park K, Hwang C, Lee Y, Koo K, Chang B . Recurrence rate of lumbar disc herniation after open discectomy in active young men. Spine (Phila Pa 1976). 2009; 34(1):24-9. DOI: 10.1097/BRS.0b013e31818f9116. View

Yorimitsu E, Chiba K, Toyama Y, Hirabayashi K . Long-term outcomes of standard discectomy for lumbar disc herniation: a follow-up study of more than 10 years. Spine (Phila Pa 1976). 2001; 26(6):652-7. DOI: 10.1097/00007632-200103150-00019. View

Kerezoudis P, Goncalves S, Cesare J, Alvi M, Kurian D, Sebastian A . Comparing outcomes of fusion versus repeat discectomy for recurrent lumbar disc herniation: A systematic review and meta-analysis. Clin Neurol Neurosurg. 2018; 171:70-78. DOI: 10.1016/j.clineuro.2018.05.023. View

Moore A, Chilton J, Uttley D . Long-term results of microlumbar discectomy. Br J Neurosurg. 1994; 8(3):319-26. DOI: 10.3109/02688699409029620. View

Li C, Chen M, Chang C, Yan J . Three-Dimensional Volumetric Changes and Clinical Outcomes after Decompression with DIAM™ Implantation in Patients with Degenerative Lumbar Spine Diseases. Medicina (Kaunas). 2020; 56(12). PMC: 7767335. DOI: 10.3390/medicina56120723. View

Swartz K, Trost G . Recurrent lumbar disc herniation. Neurosurg Focus. 2004; 15(3):E10. DOI: 10.3171/foc.2003.15.3.10. View

Krappel F, Brayda-Bruno M, Alessi G, Remacle J, Lopez L, Fernandez J . Herniectomy versus herniectomy with the DIAM spinal stabilization system in patients with sciatica and concomitant low back pain: results of a prospective randomized controlled multicenter trial. Eur Spine J. 2016; 26(3):865-876. DOI: 10.1007/s00586-016-4796-6. View

10.

Martin B, Mirza S, Comstock B, Gray D, Kreuter W, Deyo R . Are lumbar spine reoperation rates falling with greater use of fusion surgery and new surgical technology?. Spine (Phila Pa 1976). 2007; 32(19):2119-26. DOI: 10.1097/BRS.0b013e318145a56a. View

11.

Kim C, Chung C, Park C, Choi B, Kim M, Park B . Reoperation rate after surgery for lumbar herniated intervertebral disc disease: nationwide cohort study. Spine (Phila Pa 1976). 2012; 38(7):581-90. DOI: 10.1097/BRS.0b013e318274f9a7. View

12.

Dower A, Chatterji R, Swart A, Winder M . Surgical management of recurrent lumbar disc herniation and the role of fusion. J Clin Neurosci. 2015; 23:44-50. DOI: 10.1016/j.jocn.2015.04.024. View

13.

Lu K, Liliang P, Wang H, Chen J, Chen T, Huang R . Clinical outcome following DIAM implantation for symptomatic lumbar internal disk disruption: a 3-year retrospective analysis. J Pain Res. 2016; 9:917-924. PMC: 5096761. DOI: 10.2147/JPR.S115847. View

14.

Tamburrelli F, Proietti L, Logroscino C . Critical analysis of lumbar interspinous devices failures: a retrospective study. Eur Spine J. 2011; 20 Suppl 1:S27-35. PMC: 3087036. DOI: 10.1007/s00586-011-1763-0. View

15.

Floman Y, Millgram M, Smorgick Y, Rand N, Ashkenazi E . Failure of the Wallis interspinous implant to lower the incidence of recurrent lumbar disc herniations in patients undergoing primary disc excision. J Spinal Disord Tech. 2007; 20(5):337-41. DOI: 10.1097/BSD.0b013e318030a81d. View

16.

Loupasis G, Stamos K, Katonis P, Sapkas G, Korres D, Hartofilakidis G . Seven- to 20-year outcome of lumbar discectomy. Spine (Phila Pa 1976). 1999; 24(22):2313-7. DOI: 10.1097/00007632-199911150-00005. View

17.

Gazzeri R, Galarza M, Neroni M, Fiore C, Faiola A, Puzzilli F . Failure rates and complications of interspinous process decompression devices: a European multicenter study. Neurosurg Focus. 2015; 39(4):E14. DOI: 10.3171/2015.7.FOCUS15244. View

18.

Morgan-Hough C, Jones P, Eisenstein S . Primary and revision lumbar discectomy. A 16-year review from one centre. J Bone Joint Surg Br. 2003; 85(6):871-4. View

19.

Lu K, Liliang P, Wang H, Liang C, Chen J, Chen T . Reduction in adjacent-segment degeneration after multilevel posterior lumbar interbody fusion with proximal DIAM implantation. J Neurosurg Spine. 2015; 23(2):190-6. DOI: 10.3171/2014.12.SPINE14666. View

20.

Taylor J, Pupin P, Delajoux S, Palmer S . Device for intervertebral assisted motion: technique and initial results. Neurosurg Focus. 2007; 22(1):E6. DOI: 10.3171/foc.2007.22.1.6. View