Universität zu Köln

Siewe, Jan, Selbeck, Max, Koy, Timmo, Roellinghoff, Marc, Eysel, Peer, Zarghooni, Kourosh ORCID: 0000-0001-7069-6291, Oppermann, Johannes, Herren, Christian and Sobottke, Rolf (2015). Indications and Contraindications: Interspinous Process Decompression Devices in Lumbar Spine Surgery. J. Neurol. Surg. Part A, 76 (1). S. 1 - 8. NEW YORK: THIEME MEDICAL PUBL INC. ISSN 2193-6323

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Abstract

BackgroundInterspinous process decompression devices (IPD) allow a minimally invasive treatment of lumbar spinal stenosis (LSS), but their use is discussed highly controversial. Several level I studies suggest that IPD implantation is a viable alternative for both conservative treatment and decompression, but clear indications and contraindications are still missing. This study was designed to explore the perspectives and limitations of IPDs and to evaluate the role of these devices in general. Material and MethodsThe study is based on a questionnaire sent to all hospitals registered in the German Hospital Address Register 2010 with an orthopedic, neurosurgerical, or spine surgery department (n=1,321). The questionnaire was reviewed by experienced spine surgeons and statisticians, and included both single-response, close-ended, and multiple-response open-ended questions. ResultsWe received 329 (24.9%) entirely analyzable questionnaires. A total of 164 respondents (49.8%) stated that IPDs are a treatment option for LSS, and 135 of the 164 respondents (82.3%) use them. Poor clinical experience (60%) and lack of evidence (53.9%) are the main reasons cited for not using IPDs. We detected a high negative correlation between the size of the hospital, the number of outpatients and inpatients treated for LSS and other spine pathologies, and the use of IPDs (p=0.001). Most respondents prefer the combination of open decompression and IPD (64.4%; n=87). A total of 9.6% (n=13) of the users favor IPD implantation as a stand-alone procedure. Overall, 25.9% ?n=35 use both options. Most surgeons aim to relieve the facet joints (87.7%) and to stabilize a preexisting instability (75.4%). They recommend IPDs in the segments L2-L3 (77%), L3-L4 (98.5%), and L4-l5 (99.3%) and consider that IPD implanation also could be done at the L5-S1 segment (40.1%). Overall, 64.4% (n=87) of the users recommend limiting IPD implantation to two segments. Infection (96.3%), fracture (94.8%), isthmic spondylolisthesis (77%), degenerative spondylolisthesis (higher than Meyerding I [57%]), lumbar spine scoliosis (48.1%), and osteoporosis (50.4%) are seen as contraindications for IPD. Conclusion No clear consensus exists among spine surgeons concerning the use of IPD for LSS treatment. The study showed that hospital-related parameters also influence decision making for or against the use of IPDs. However, despite the lack of evidence, the indications and contraindications which had been identified in the present study might contribute to improved outcomes after IPD implantation or at least prevent harm to patients.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Siewe, Jan UNSPECIFIED UNSPECIFIED UNSPECIFIED Selbeck, Max UNSPECIFIED UNSPECIFIED UNSPECIFIED Koy, Timmo UNSPECIFIED UNSPECIFIED UNSPECIFIED Roellinghoff, Marc UNSPECIFIED UNSPECIFIED UNSPECIFIED Eysel, Peer UNSPECIFIED UNSPECIFIED UNSPECIFIED Zarghooni, Kourosh UNSPECIFIED orcid.org/0000-0001-7069-6291 UNSPECIFIED Oppermann, Johannes UNSPECIFIED UNSPECIFIED UNSPECIFIED Herren, Christian UNSPECIFIED UNSPECIFIED UNSPECIFIED Sobottke, Rolf UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-417323
DOI:	10.1055/s-0034-1382779
Journal or Publication Title:	J. Neurol. Surg. Part A
Volume:	76
Number:	1
Page Range:	S. 1 - 8
Date:	2015
Publisher:	THIEME MEDICAL PUBL INC
Place of Publication:	NEW YORK
ISSN:	2193-6323
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language NEUROGENIC INTERMITTENT CLAUDICATION; 2-YEAR FOLLOW-UP; X-STOP; STENOSIS; FUSION; COMPLICATIONS; SPACERS; IMPLANTATION; MULTICENTER; SYSTEM Multiple languages Clinical Neurology; Surgery Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/41732