title: [Treatment of dynamic spinal canal stenosis with an interspinous spacer].
abstract: OBJECTIVE
  Indirect decompression of the spinal canal and the neuroforamina by means of interspinous process distraction and limitation of extension movements. Reduction of forces acting on the posterior joint structures of a functional spinal unit (posterior anulus, facet joints, intervertebral discs).
  
  
  METHODS
  Primary indication: Spinal claudication with improvement of the clinical symptomatology upon taking an inclined position. Secondary indication: Low back pain in the presence of accompanying retrolisthesis. Hyperlordosis Facet joint complaints Annulus lesions with high intensity zones (HIZ) M. Baastrup ("kissing spine"). Adjacent segment preservation (e.g. prophylaxis of recurrent disc herniation after discectomy or topping-off following previous fusion).
  
  
  METHODS
  Spinal instabilities which prohibit a solid fixation of the implant (e.g. spondylolysis, isthmus fractures, condition following previous (hemi-) laminectomy) Degenerative spondylolisthesis ffl 1st degree. Severe structural narrowing of the spinal canal. Absent dynamic aspect without improvement upon inclination, segmental ankylosis.
  
  
  METHODS
  Positioning of the patient in an inclined position. Approximately 4 cm median skin incision, bilateral access with preservation of the supraspinous ligament. Perforation of the interspinous ligament. Following interspinous distraction the adequate size implant is established. Insertion of the interspinous process distraction device (IPD) unit and fixation of the mobile wing unit from the contralateral side. Medial positioning and solid fixation of the implant by connecting the two implant units.
  
  
  METHODS
  Lumbar orthosis (optional), otherwise no further support required. Daily living activities immediately after the operation. Physiotherapeutic exercises (optional). Low impact sporting activities from 2nd week after operation, intense/ high impact sporting activities from 6 months postoperatively.
  
  
  RESULTS
  Previous studies have reported satisfactory results for interspinous distraction devices for the treatment of dynamic spinal canal stenosis. However, the majority of these previously published studies are based on data with only shortterm follow-up or small patient numbers. In particular, the results of interspinous spacers for the treatment of different indications have not been evaluated separately. Complications and long-term results still need to be established.
authors.affiliation: Wirbelsäulenzentrum, Schön Klinik München Harlaching, München, Germany. CSiepe@Schoen-Kliniken.de
authors.forename: Christoph J
authors.initials: CJ
authors.lastname: Siepe
authors.forename: Franziska
authors.initials: F
authors.lastname: Heider
authors.forename: Rudolf
authors.initials: R
authors.lastname: Beisse
authors.forename: H Michael
authors.initials: HM
authors.lastname: Mayer
authors.forename: Andreas
authors.initials: A
authors.lastname: Korge
mesh_terms: D001178:Arthroplasty / Q000295:instrumentation; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications* / Q000601:surgery*; D008297:Male; D019857:Osteogenesis, Distraction / Q000295:instrumentation; D019736:Prostheses and Implants; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000379:methods*; D013130:Spinal Stenosis / Q000150:complications* / Q000601:surgery*; D016896:Treatment Outcome; D021801:Zygapophyseal Joint / Q000601:surgery*