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Study Design: Prospective randomized controlled study., Objective: To compare the outcome of indirect decompression by means of the X-Stop (Medtronics Inc., Minneapolis, MN) implant with conventional decompression in patients with neurogenic intermittent claudication due to lumbar spinal stenosis., Summary of Background Data: Decompression is currently the "gold standard" for lumbar spinal stenosis but is afflicted with complications and a certain number of dissatisfied patients. Interspinous implants have been on the market for more than 10 years, but no prospective study comparing its outcome with decompression has been performed., Methods: After power calculation, 100 patients were included: 50 in the X-Stop group and 50 in the decompression group. Patients with symptomatic 1- or 2-level lumbar spinal stenosis and neurogenic claudication relieved on flexion were included. X-Stop operations were performed under local anesthesia.The mean patient age was 69 (49-89) years, and the male/female distribution was 56/44. Minimal dural sac area was in all cases except two 80 mm or less.The noninferiority hypothesis included 6, 12, and 24 months of follow-up, and included. intention-to-treat as well as as-treated analyses.The primary outcome meansure was the Zürich Claudication Questionnaire, and the secondary outcome measures was the visual analogue scale pain, Short-Form 36 (SF-36), complications, and reoperations., Results: The primary and secondary outcome measures of patients in both groups improved significantly. The results were similar at 6, 12, and 24 months and at no time point could any statistical difference between the 2 types of surgery be identified. Three patients (6%) in the decompression group underwent further surgery, compared with 13 patients (26%) in the X-Stop group (P = 0.04). Results were identical in intention-to-treat and as-treated analyses., Conclusion: For spinal stenosis with neurogenic claudication, decompressive surgery as well as X-Stop are appropriate procedures. Similar results were achieved in both groups, however, with a higher number of reoperations in the X-Stop group. Patients having X-Stop removal and decompression experienced results similar to those randomized to primary decompression., Level of Evidence: 1.

In this prospective study, the clinical outcome in the early course as well as the long-term results were analyzed after automated percutaneous lumbar discectomy (APLD). Thirty consecutive patients are included, all with a contained lumbar disc herniation on magnetic resonance imaging. There was a significant reduction in the sciatic pain and straight leg raising (SLR) test postoperatively at all the different measurements in the early course except for the sciatic pain at 2 weeks. On the same occasions, there was no change in the back pain or the Oswestry score. Ten patients needed subsequent open surgery. For the remaining patients, the long-term result showed a significant and unchanged improvement in the sciatic pain and SLR. In addition, the Oswestry score had now significantly improved. The failure rate of APLD turned out to be unacceptably high in this study, because 38% of the patients needed subsequent open surgery. However, an early satisfactory course also seemed to imply a beneficial long-term prognosis.

The authors evaluated the size of the disc herniation with magnetic resonance imaging (MRI) before and after surgery in patients undergoing automated percutaneous lumbar discectomy (APLD) and compared the MRI findings with the early clinical outcome. This study includes 20 consecutive patients with a contained lumbar disc herniation. Sequential MRI were performed immediately before and after surgery, on the day of surgery, and 6 weeks after surgery. The development of pain, nerve root tension sign (SLR), and neurological findings were analyzed, as was the need for subsequent open surgery. There was no significant difference in the maximum protrusion of the disc herniation between the three measurements. The sciatic pain improved significantly on the first day after surgery but not at 1 week or 6 weeks after surgery. The SLR was reduced significantly after surgery and at 1 and 6 weeks after surgery. There was no correlation between the MRI findings and the early clinical outcome. Seven patients needed subsequent open surgery. The findings indicate that the effect of APLD is not mediated by reducing the size of the disc herniation. In this small series of patients, APLD was ineffective in the treatment of a contained lumbar disc herniation. There was no correlation between the MRI findings and the early clinical outcome.