title: Interspinous spacer versus traditional decompressive surgery for lumbar spinal stenosis: a systematic review and meta-analysis.
abstract: BACKGROUND
  Dynamic interspinous spacers, such as X-stop, Coflex, DIAM, and Aperius, are widely used for the treatment of lumbar spinal stenosis. However, controversy remains as to whether dynamic interspinous spacer use is superior to traditional decompressive surgery.
  
  
  METHODS
  Medline, Embase, Cochrane Library, and the Cochrane Controlled Trials Register were searched during August 2013. A track search was performed on February 27, 2014. Study was included in this review if it was: (1) a randomized controlled trial (RCT) or non-randomized prospective comparison study, (2) comparing the clinical outcomes for interspinous spacer use versus traditional decompressive surgery, (3) in a minimum of 30 patients, (4) with a follow-up duration of at least 12 months.
  
  
  RESULTS
  Two RCTs and three non-randomized prospective studies were included, with 204 patients in the interspinous spacer (IS) group and 217 patients in the traditional decompressive surgery (TDS) group. Pooled analysis showed no significant difference between the IS and TDS groups for low back pain (WMD: 1.2; 95% CI: -10.12, 12.53; P = 0.03; I2 = 66%), leg pain (WMD: 7.12; 95% CI: -3.88, 18.12; P = 0.02; I2 = 70%), ODI (WMD: 6.88; 95% CI: -14.92, 28.68; P = 0.03; I2 = 79%), RDQ (WMD: -1.30, 95% CI: -3.07, 0.47; P = 0.00; I2 = 0%), or complications (RR: 1.39; 95% CI: 0.61, 3.14; P = 0.23; I2 = 28%). The TDS group had a significantly lower incidence of reoperation (RR: 3.34; 95% CI: 1.77, 6.31; P = 0.60; I2 = 0%).
  
  
  CONCLUSIONS
  Although patients may obtain some benefits from interspinous spacers implanted through a minimally invasive technique, interspinous spacer use is associated with a higher incidence of reoperation and higher cost. The indications, risks, and benefits of using an interspinous process device should be carefully considered before surgery.
authors.affiliation: The Department of Spinal Surgery, Second Affiliated Hospital of Wenzhou Medical University, Zhejiang Spinal Research Center, Wenzhou, Zhejiang, People's Republic of China.
authors.forename: Ai-Min
authors.initials: AM
authors.lastname: Wu
authors.affiliation: The First Medical College, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: The Department of Spinal Surgery, Second Affiliated Hospital of Wenzhou Medical University, Zhejiang Spinal Research Center, Wenzhou, Zhejiang, People's Republic of China.
authors.forename: Qing-Long
authors.initials: QL
authors.lastname: Li
authors.affiliation: Institute of Digitized Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China.
authors.forename: Xin-Lei
authors.initials: XL
authors.lastname: Wu
authors.affiliation: The Department of Spinal Surgery, Second Affiliated Hospital of Wenzhou Medical University, Zhejiang Spinal Research Center, Wenzhou, Zhejiang, People's Republic of China.
authors.forename: Yong-Long
authors.initials: YL
authors.lastname: Jin
authors.affiliation: The Department of Spinal Surgery, Second Affiliated Hospital of Wenzhou Medical University, Zhejiang Spinal Research Center, Wenzhou, Zhejiang, People's Republic of China.
authors.forename: Peng
authors.initials: P
authors.lastname: Luo
authors.affiliation: The Department of Spinal Surgery, Second Affiliated Hospital of Wenzhou Medical University, Zhejiang Spinal Research Center, Wenzhou, Zhejiang, People's Republic of China.
authors.forename: Yong-Long
authors.initials: YL
authors.lastname: Chi
authors.affiliation: The Department of Spinal Surgery, Second Affiliated Hospital of Wenzhou Medical University, Zhejiang Spinal Research Center, Wenzhou, Zhejiang, People's Republic of China.
authors.forename: Xiang-Yang
authors.initials: XY
authors.lastname: Wang
mesh_terms: D019299:Decompression, Surgical / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D012086:Reoperation; D013130:Spinal Stenosis / Q000601:surgery*; D016896:Treatment Outcome