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Role of lumbar interspinous distraction on the neural elements.
- Source :
-
Neurosurgical review [Neurosurg Rev] 2012 Oct; Vol. 35 (4), pp. 477-84; discussion 484. Date of Electronic Publication: 2012 May 02. - Publication Year :
- 2012
-
Abstract
- The interspinous distraction devices are used to treat variable pathologies ranging from facet syndrome, diskogenic low back pain, degenerative spinal stenosis, diskopathy, spondylolisthesis, and instability. The insertion of a posterior element with an interspinous device (ISD) is commonly judged responsive to a relative kyphosis of a lumbar segment with a moderate but persistent increase of the spinal canal and of the foraminal width and area, and without influence on low-grade spondylolisthesis. The consequence is the need of shared specific biomechanical concepts to give for each degenerative problem the right indication through a critical analysis of all available experimental and clinical biomechanical data. We reviewed systematically the available clinical and experimental data about kyphosis, enlargement of the spinal canal, distraction of the interspinous distance, increase of the neural foramina, ligamentous structures, load of the posterior annulus, intradiskal pressure, strength of the spinous processes, degeneration of the adjacent segment, complications, and cost-effectiveness of the ISD. The existing literature does not provide actual scientific evidence over the superiority of the ISD strategy, but most of the experimental and clinical data show a challenging potential. These considerations are applicable with different types of ISD with only few differences between the different categories. Despite--or because of--the low invasiveness of the surgical implantation of the ISD, this technique promises to play a major role in the future degenerative lumbar microsurgery. The main indications for ISD remain lumbar spinal stenoses and painful facet arthroses. A clear documented contraindication is the presence of an anterolisthesis. Nevertheless, the existing literature does not provide evidence of superiority of outcome and cost-effectiveness of the ISD strategy over laminectomy or other surgical procedures. At this time, the devices should be used in clinical randomized independent trials in order to obtain more information concerning the most advantageous optimal indication or, in selected cases, to treat tailored indications.
- Subjects :
- Biomechanical Phenomena
Costs and Cost Analysis
Humans
Joint Instability
Kyphosis complications
Kyphosis pathology
Osteogenesis, Distraction economics
Osteogenesis, Distraction instrumentation
Spinal Canal surgery
Spinal Diseases pathology
Spinal Diseases surgery
Spinal Stenosis pathology
Spinal Stenosis surgery
Spine anatomy & histology
Treatment Outcome
Osteogenesis, Distraction methods
Spine surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1437-2320
- Volume :
- 35
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Neurosurgical review
- Publication Type :
- Academic Journal
- Accession number :
- 22549123
- Full Text :
- https://doi.org/10.1007/s10143-012-0394-1