Role of coflex as an adjunct to decompression for symptomatic lumbar spinal stenosis.
METHODS
Prospective cohort study.


OBJECTIVE
To assess whether additional implantation of Coflex following spinal decompression provided better clinical outcomes compared to decompression alone for symptomatic lumbar spinal stenosis (LSS) and to determine whether improvement in clinical outcomes correlated with changes in the radiological indices studied.


BACKGROUND
Literature on benefits of additional Coflex implantation compared to decompression alone for symptomatic LSS is limited.


METHODS
Patients with symptomatic LSS who met the study criteria were offered spinal decompression with Coflex implantation. Those patients who accepted Coflex implantation were placed in the Coflex group (n=22); while those opting for decompression alone, were placed in the comparison group (n=24). Clinical outcomes were assessed preoperatively, six-months, one-year and two-years postoperatively, using the Oswestry disability index, 100 mm visual analogue scale (VAS)-back pain and VAS-leg pain, and short form-36 (SF-36). Radiological indices (disc height, foraminal height and sagittal angle) were assessed preoperatively, six months, one year, and two years postoperatively.


RESULTS
Both groups showed statistically significant (p<0.001) improvement in all the clinical outcome indicators at all points in time as compared to the preoperative status. However, improvement in the Coflex group was significantly greater (p<0.001) than the comparison group. Changes in the radiological indices did not correlate significantly with the improvement in clinical outcome indicators.


CONCLUSIONS
Additional Coflex implantation after spinal decompression in symptomatic LSS offers better clinical outcomes than decompression alone in the short-term. Changes in radiological indices do not correlate with the improvements in clinical outcomes after surgery for symptomatic LSS.
University Spine Centre, National University Hospital, Singapore, Singapore.
Naresh
N
Kumar
Department of Orthopaedic Surgery, National University Hospital, Singapore, Singapore.
Siddarth M
SM
Shah
Department of Orthopaedic Surgery, National University Hospital, Singapore, Singapore.
Yau Hong
YH
Ng
Department of Orthopaedic Surgery, National University Hospital, Singapore, Singapore.
Vinodh Kumar
VK
Pannierselvam
Department of Orthopaedic Surgery, National University Hospital, Singapore, Singapore.
Sudeep
S
Dasde
Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
Liang
L
Shen
Coflex; Decompression; Interspinous process device; Spinal stenosis