A Change in the Parameters of the Spine Following the Implantati on of a Lumbar Interspino us Spacer DIAM

Česká verzia

Authors: L. Hrabálek ¹; J. Novotný ²; J. Koluchová ²; M. Vaverka ¹; O. Kalita ¹; K. Langová ³
Authors place of work: Ne urochirurgická klinika LF UP a FN Olomo uc, 2Radi ologické oddělení FN Olomo uc, 3Ústav lékařské biofyziky LF UP v Olomo uci ¹
Published in the journal: Cesk Slov Neurol N 2009; 72/105(4): 337-342
Category: Original Paper

Summary

One dynamic stabilizati on technique is the implantati on of an “interspino us spacer” between the spino us processes of the lumbar spine. The objective of this study was to verify whether, following implantati on of the DIAM interspino us spacer (Medtronic, USA), there was any space distracti on, whether the sagittal angle of the lumbar spine had changed and whether mobility of the operated segment was maintained. Pati ents suffering from degenerative lumbosacral spine dise ase due to a herni a of the disc or foraminostenosis and accompani ed by axi al pain and radicular symptoms, were indicated for the operati on. The pati ent gro up consisted of 17 pati ents (7 women and 10 men) in the age range of 23 to 66 (the average age was 45.58). Pri or to the operati on and one month following the operati on the pati ents assessed VAS for axi al and radicular pain and simultane o usly underwent a dynamic ski agram of the lumbosacral spine, a static ski agram of the lumbosacral spine pri or to the operati on and one week after, as well as undergo ing a CT examinati on me asuring the height of both intervertebral foramen and the back and front heights of the disc. Implantati on of the DIAM spacer ca used distracti on of the operated segment of the lumbar spine in the order of tenths of a millimeter, ca used lordotizati on of the lumbar spinal cord by 1.65° on average and maintained the mobility of the operated segment with an average range of 11.38°. The average VAS for axi al pain improved from 5.7 to 0.47 po ints and from 5.9 to 0.41 for radicular pain. The low “intra‑observer” and “inter‑observer” vari ability of repe ated me asurements of the heights was demonstrated by CT scan. In conclusi on, the a uthors state that the DIAM spacer ca uses only slight distracti on of the entire operated segment of the lumbar spine on average; for this re ason it is impossible to rely on the effect of indirect decompressi on on exiting nerve ro ots. The implant can ca use kyphotizati on of the spine and therefore, the use of interspino us spacers in those pati ents demonstrating pre‑operative signs of kyphosis of the operated segment must be seri o usly considered beforehand.

Key words:
low back pain – implants – dynamic spine stabilization

Zdroje

1. Christi e SD, Song JK, Fessler RG. Dynamic interspino us process technology. Spine 2005; 30 (Suppl 16): S73– S78.

2. Mulholland RC, Sengupta DK. Rati onale, principles and experimental evalu ati on of the concept of soft stabilizati on. Eur Spine J 2002; 11 (Suppl 2): S198– S205.

3. Sengupta DK. Dynamic stabilizati on device in the tre atment of low back pain. Orthop Clin North Am 2004; 35(1): 43– 56.

4. Andersson GB, Burkus JK, Foley KT, Haid RW, Nockels RP, Polly DW jr et al. Summary statement: tre atment of the painful moti on segment. Spine 2005; 30 (Suppl 16): S1.

5. Polly DW, Santos ERG, Mehbod AA. Surgical tre atment for the painful moti on segment. Matching Technology with the Indicati ons: Posteri or Lumbar Fusi on. Spine 2005; 30 (Suppl 16): S44– S50.

6. Wang JC, Mummaneni PV, Haid RW. Current tre atment strategi es for the painful lumbar moti on segment: posterolateral fusi on versus interbody fusi on. Spine 2005; 30 (Suppl 16): S33– S43.

7. Minns RJ, Walsh WK. Preliminary design and experimental studi es of a novel soft implant for correcting sagittal plane instability in the lumbar spine. Spine 1997; 22(16): 1819– 1827.

8. Sénégas J. Mechanical supplementati on by non‑rigid fixati on in degenerative intervertebral lumbar segments: the Wallis system. Eur Spine J 2002; 11 (Suppl 2): S164– S169.

9. Wiseman CM, Lindsey DP, Fredrick AD, Yerby SA. The effect of an interspino us process implant on facet lo ading during extensi on. Spine 2005; 30(8): 903– 907.

10. Swanson KE, Lindsey DP, Hsu KY, Zucherman JF, Yerby SA. The effects of an interspino us implant on intervertebral disc pressures. Spine 2003; 28(1): 26– 32.

11. Lindsey DP, Swanson KE, Fuchs P, Hsu KY, Zucherman JF, Yerby SA. The effects of an interspino us implant on the kinematics of the instrumented and adjacent levels in the lumbar spine. Spine 2003; 28(19): 2192– 2197.

12. Richards JC, Majumdar S, Lindsey DP, Be a upré GS, Yerby SA. The tre atment mechanism of an interspino us process implant for lumbar ne urogenic intermittent cla udicati on. Spine 2005; 30(7): 744– 749.

13. Aota Y, Kumano K, Hirabayashi S. Postfusi on instability at the adjacent segments after rigid pedicle screw fixati on for degenerative lumbar spinal disorders. J Spinal Disord 1995; 8(6): 464– 473.

14. Kumar MN, Jacquot F, Hall H. Long‑term follow‑up of functi onal o utcomes and radi ographic changes at adjacent levels following lumbar spine fusi on for degenerative disc dise ase. Eur Spine J 2001; 10(4): 309– 313.

15. Schlegel JD, Smith JA, Schle usener RL. Lumbar moti on segment pathology adjacent to thoracolumbar, lumbar, and lumbosacral fusi ons. Spine 1996; 21(8): 970– 881.

16. Caserta S, La Maida GA, Misaggi B, Peroni D, Pi etrabissa R, Raimondi MT at al. Elastic stabilizati on alone or combined with rigid fusi on in spinal surgery: a bi omechanical experi ence based on 82 cases. Eur Spine J 2002; 11 (Suppl 2): S192– S197.

17. Schi avone AM, Pasqu ale G. The use of disc assistance prostheses (DIAM) in degenerative lumbar patology: Indicati ons, technique, and results. Ital J Spinal Disord 2003; 3: 213– 220.

18. Siddiqui M, Karadimas E, Nicol M, Smith FW, Wardlaw D. Influence of X Stop on ne ural foramina and spinal canal are a in spinal stenosis. Spine 2006; 31(25): 2958– 2962.

19. Smith FW. P MRI changes in the lumbar spine following inserti on of the X STOP interspino us process decompressi on device. Brussels Internati onal Spine Symposi um 2005.

20. Carlsson AM. Assessment of chronic pain: I. Aspects of the reli ability and validity of the visu al analogue scale. Pain 1983; 16(1): 87– 101.

21. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical me asurement. Lancet 1986; 1(8476): 307– 310.

22. Kim KA, McDonald M, Pik JH, Kho ueir P, Wang MY. Dynamic intraspino us spacer technology for posteri or stabilizati on: case-control study on the safety, sagittal angulati on, and pain o utcome at 1- ye ar follow‑up evalu ati on. Ne urosurg Focus 2007; 22(1): E7.

23. Seel EH, Verrill CL, Mehta RL, Davi es EM. Me asurement of fracture kyphosis with the Oxford cobbometer: intra- and interobserver reli abiliti es and comparison with other techniques. Spine 2005; 30(8): 964– 968.

24. Mari ottini A, Pi eri S, Gi achi S, Carangelo B, Zalaffi A, Muzii FV et al. Preliminary results of a soft novel lumbar intervertebral prothesis (DIAM) in the degenerative spinal pathology. Acta Ne urochir Suppl 2005; 92: 129– 131.

25. Zucherman JF, Hsu KY, Hartjen ChA, Mehalic TF, Implicite DA, Martin MJ et al. A multicenter, prospective, randomized tri al evalu ati on the X STOP interspino us process decompressi on system for the tre atment of ne urogenic intermittent cla udicati on. Spine 2005; 30(12): 1351– 1358.