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Object: This study was conducted to compare the quality of life (QOL) in patients with neurogenic intermittent claudication (NIC) secondary to lumbar spinal stenosis (LSS). Using the 36-Item Short Form (SF-36) questionnaire, the authors compared the results obtained in patients treated with the X STOP Interspinous Process Decompression (IPD) System with those obtained in patients who underwent nonoperative therapies., Methods: Patients with LSS were enrolled in a prospective 2-year multicenter study and randomized either to the X STOP or nonoperative group. The SF-36 survey was used to assess the QOL before treatment and at 6 weeks, 6 months, 1 year, and 2 years posttreatment. An analysis of variance was used to compare individual pre- and posttreatment mean SF-36 domain scores between the two groups and within each treatment group. At all posttreatment time points, the authors observed the following: (1) mean domain scores in X STOP-treated patients were significantly greater than those in patients treated nonoperatively, with the exception of the mean General Health (GH), Role Emotional, and Mental Component Summary scores at 2 years; and (2) mean posttreatment domain scores documented in X STOP-treated patients were significantly greater than mean pretreatment scores, with the exception of mean GH scores at 6, 12, and 24 months., Conclusions: The results of this study demonstrate that the X STOP device is significantly more effective than nonoperative therapy in improving the QOL in patients with LSS. The results are comparable with those reported in other studies involving traditional decompressive techniques for LSS and suggest that the X STOP implant can provide an effective treatment compared with nonoperative and conventional surgical therapies.

Study Design: A randomized, controlled, prospective multicenter trial comparing the outcomes of neurogenic intermittent claudication (NIC) patients treated with the interspinous process decompression system (X STOP) with patients treated nonoperatively., Objective: To determine the safety and efficacy of the X STOP interspinous implant., Summary of Background Data: Patients suffering from NIC secondary to lumbar spinal stenosis have been limited to a choice between nonoperative therapies and decompressive surgical procedures, with or without fusion. The X STOP was developed to provide an alternative therapeutic treatment. METHODS.: 191 patients were treated, 100 in the X STOP group and 91 in the control group. The primary outcomes measure was the Zurich Claudication Questionnaire, a patient-completed, validated instrument for NIC., Results: At every follow-up visit, X STOP patients had significantly better outcomes in each domain of the Zurich Claudication Questionnaire. At 2 years, the X STOP patients improved by 45.4% over the mean baseline Symptom Severity score compared with 7.4% in the control group; the mean improvement in the Physical Function domain was 44.3% in the X STOP group and -0.4% in the control group. In the X STOP group, 73.1% patients were satisfied with their treatment compared with 35.9% of control patients., Conclusions: The X STOP provides a conservative yet effective treatment for patients suffering from lumbar spinal stenosis. In the continuum of treatment options, the X STOP offers an attractive alternative to both conservative care and decompressive surgery.

Patients suffering from neurogenic intermittent claudication secondary to lumbar spinal stenosis have historically been limited to a choice between a decompressive laminectomy with or without fusion or a regimen of non-operative therapies. The X STOP Interspinous Process Distraction System (St. Francis Medical Technologies, Concord, Calif.), a new interspinous implant for patients whose symptoms are exacerbated in extension and relieved in flexion, has been available in Europe since June 2002. This study reports the results from a prospective, randomized trial of the X STOP conducted at nine centers in the U.S. Two hundred patients were enrolled in the study and 191 were treated; 100 received the X STOP and 91 received non-operative therapy (NON OP) as a control. The Zurich Claudication Questionnaire (ZCQ) was the primary outcomes measurement. Validated for lumbar spinal stenosis patients, the ZCQ measures physical function, symptom severity, and patient satisfaction. Patients completed the ZCQ upon enrollment and at follow-up periods of 6 weeks, 6 months, and 1 year. Using the ZCQ criteria, at 6 weeks the success rate was 52% for X STOP patients and 10% for NON OP patients. At 6 months, the success rates were 52 and 9%, respectively, and at 1 year, 59 and 12%. The results of this prospective study indicate that the X STOP offers a significant improvement over non-operative therapies at 1 year with a success rate comparable to published reports for decompressive laminectomy, but with considerably lower morbidity.

Background Context: Threaded lumbar cages have been used as a safe and effective surgical fusion method for a decade. Smaller versions have now been developed for the cervical spine to obviate the need for allograft use or iliac autograft harvest and to provide initial stability before fusion., Purpose: To compare anterior cervical interbody fusion with the BAK/C Cervical Interbody Fusion System, cage (Centerpulse Spine-Tech Inc., Minneapolis, MN), conventional anterior cervical discectomy and fusion (ACDF) and plate constructs (anterior cervical locking plates)., Study Design/setting: Radiological and clinical outcomes of patients who underwent cervical fusion with the BAK/C (filled with local autograft reamings) are compared with ACDF and plate fusion constructs (anterior cervical locking plates). One surgeon performed 88 fusions: BAK/C (n=30), ACDF (n=32), plate (n=26). There were 43 one-level and 45 two-level fusions from C3-C4 to C7-T1., Patient Sample: The patients represented a wide range of diagnoses as indications for cervical fusion. Patients (n=88) were 40 men (45%) and 48 women (55%) with a mean age of 51 years (range, 30 to 70 years). Thirty-five percent of patients were smokers, and 26% had known workers' or other compensation issues., Outcome Measures: Hospital records were examined for data from operative reports and discharge summaries. An independent spine radiologist performed a radiological review of cervical flexion and extension films, noting fusion status, graft position and cage subsidence. Short Form (SF)-36 inventories for physical/mental functioning and visual analog scales (VAS) for pain were administered., Methods: A retrospective clinical and radiological review was performed. Hospital and clinic chart data, flexion-extension X-rays and self-assessments (SF-36, VAS) were evaluated. Follow-up at X-ray was 2.4 years (range, 1.0 to 5.5 years)., Results: Iliac crest harvesting was least likely for BAK/C patients (2 of 30; 6.7%) compared with ACDF (30 of 32; 93.8%) and plate patients (13 of 26; 50.0%; p<.0001). Plate surgeries took longest (3.5 hours), followed by ACDF (2.3 hours) and BAK/C (2.2 hours; p<.0001). Blood loss was greatest for plate procedures (289 cc), followed by BAK/C (142 cc) and ACDF (121 cc; p<.01). No BAK/C patient stayed in the hospital more than 1 day; ACDF, 1 to 2 days; plate, 1 to 5 days (p<.02). BAK/C patients were most likely to have a successful fusion: BAK/C, 29 of 30, 97%; ACDF, 26 of 31, 84% (one X-ray fusion status indeterminate); plate, 22 of 26, 85% (p<.0585). No BAK/C patient experienced prolonged donor-site pain (0%) compared with ACDF (25.0%) and plate (23.0%) patients. SF-36 and VAS scores, influenced by compensation, were comparable for all groups. Revisions were as follows: ACDF, 4 of 32, 13%; plate, 2 of 26, 8%); BAK/C, 1 of 30, 3%)., Conclusions: In this study, the BAK/C cage group had the lowest graft requirements/risks, generally required fewer hospital resources, achieved similar patient outcomes and fused at a higher rate than ACDF and plate groups.

Two cases of arteriovenous malformation of the choroid plexus are presented, bringing the number of such cases reported to 16. One of these was successfully removed surgically after two episodes of intraventricular hemorrhage. The other was found incidently at autopsy and had produced an asymmetric hydrocephalus. Overproduction with a more forceful propulsion of cerebrospinal fluid may be the mechanism producing this effect. These lesions should be considered in cases of unexplained intraventricular hemorrhage.

A series of 120 patients with pain syndromes of varying sources were subjected to peripheral nerve electrical stimulation. Transcutaneous, percutaneous and depth electrode stimulation methods were employed. Thirty-eight patients obtained definite relief and twenty obtained equivocal relief. The remaining 62 patients obtained no relief. Pain sources are correlated with treatment results.