24-Month Outcomes of Indirect Decompression Using a Minimally Invasive Interspinous Fixation Device versus Standard Open Direct Decompression for Lumbar Spinal Stenosis: A Prospective Comparison

被引:1
作者
Baranidharan, Ganesan [1 ,2 ]
Bretherton, Beatrice [1 ,3 ]
Feltbower, Richard G. [4 ]
Timothy, Jake [5 ]
Khan, Almas Latif [6 ,7 ]
Subramanian, Ashok [8 ]
Ahmed, Mushtaq [9 ]
Crowther, Tracey A. [1 ,10 ]
Radford, Helen [10 ,11 ]
Gupta, Harun [12 ]
Chandramohan, Muthusamy [13 ]
Beall, Douglas P. [14 ]
Deer, Timothy R. [15 ]
Hedman, Thomas [16 ]
机构
[1] Leeds Teaching Hosp NHS Trust, Pain Management Dept, Leeds, England
[2] Univ Leeds, Sch Med, Leeds, England
[3] Univ Leeds, Fac Biol Sci, Sch Biomed Sci, Leeds, England
[4] Univ Leeds, Leeds Inst Data Analyt, Sch Med, Leeds, England
[5] Leeds Teaching Hosp NHS Trust, Dept Neurosci, Leeds, England
[6] Leeds Teaching Hosp NHS Trust, Dept Spine Surg, Leeds, England
[7] Univ Leeds, Inst Med & Biol Engn, Leeds, England
[8] Musgrove Pk Hosp, Somerset Spinal Surg Serv, Taunton, England
[9] Dudley Grp NHS Fdn Trust, Dept Trauma & Orthopaed Surg, Dudley, England
[10] Leeds Teaching Hosp NHS Trust, Res & Innovat, Leeds, England
[11] Univ Leeds, Leeds Inst Clin Trials Res, Leeds, England
[12] Leeds Teaching Hosp NHS Trust, Dept Radiol, Leeds, England
[13] Bradford Teaching Hosp NHS Fdn Trust, Radiol Dept, Bradford, England
[14] Comprehens Specialty Care, Edmond, OK USA
[15] Spine & Nerve Ctr Virginias, Charleston, WV USA
[16] Univ Kentucky, Dept Biomed Engn, Lexington, KY USA
来源
JOURNAL OF PAIN RESEARCH | 2024年 / 17卷
关键词
lumbar spinal stenosis; surgical decompression; posterior lateral arthrodesis; patient reported outcomes; minimally invasive spine; interspinous fixation device; X-STOP; INTERMITTENT CLAUDICATION; NEUROGENIC CLAUDICATION; FUSION; MULTICENTER; SPACER; IMPLANT; SURGERY;
D O I
10.2147/JPR.S453343
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Purpose: An early-stage, multi-centre, prospective, randomised control trial with five-year follow-up was approved by Health Research Authority to compare the efficacy of a minimally invasive, laterally implanted interspinous fixation device (IFD) to open direct surgical decompression in treating lumbar spinal stenosis (LSS). Two-year results are presented. Patients and Methods: Forty-eight participants were randomly assigned to IFD or decompression. Primary study endpoints included changes from baseline at 8-weeks, 6, 12 and 24-months follow-ups for leg pain (visual analogue scale, VAS), back pain (VAS), disability (Oswestry Disability Index, ODI), LSS physical function (Zurich Claudication Questionnaire), distance walked in five minutes and number of repetitions of sitting-to-standing in one minute. Secondary study endpoints included patient and clinician global impression of change, adverse events, reoperations, operating parameters, and fusion rate. Results: Both treatment groups demonstrated statistically significant improvements in mean leg pain, back pain, ODI disability, LSS physical function, walking distance and sitting-to-standing repetitions compared to baseline over 24 months. Mean reduction of ODI from baseline levels was between 35% and 56% for IFD (p<0.002), and 49% to 55% for decompression (p<0.001) for all follow-up time points. Mean reduction of IFD group leg pain was between 57% and 78% for all time points (p<0.001), with 72% to 94% of participants having at least 30% reduction of leg pain from 8-weeks through 24-months. Walking distance for the IFD group increased from 66% to 94% and sitting-to-standing repetitions increased from 44% to 64% for all follow-up time points. Blood loss was 88% less in the IFD group (p=0.024) and operating time parameters strongly favoured IFD compared to decompression (p<0.001). An 89% fusion rate was assessed in a subset of IFD participants. There were no intraoperative device issues or re-operations in the IFD group, and only one healed and non-symptomatic spinous process fracture observed within 24 months. Conclusion: Despite a low number of participants in the IFD group, the study demonstrated successful two-year safety and clinical outcomes for the IFD with significant operation -related advantages compared to surgical decompression.
引用
收藏
页码:2079 / 2097
页数:19
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