title: Indications and contraindications: interspinous process decompression devices in lumbar spine surgery.
abstract: BACKGROUND
  Interspinous process decompression devices (IPD) allow a minimally invasive treatment of lumbar spinal stenosis (LSS), but their use is discussed highly controversial. Several level I studies suggest that IPD implantation is a viable alternative for both conservative treatment and decompression, but clear indications and contraindications are still missing. This study was designed to explore the perspectives and limitations of IPDs and to evaluate the role of these devices in general.
  
  
  METHODS
  The study is based on a questionnaire sent to all hospitals registered in the German Hospital Address Register 2010 with an orthopedic, neurosurgerical, or spine surgery department (n = 1,321). The questionnaire was reviewed by experienced spine surgeons and statisticians, and included both single-response, close-ended, and multiple-response open-ended questions.
  
  
  RESULTS
  We received 329 (24.9%) entirely analyzable questionnaires. A total of 164 respondents (49.8%) stated that IPDs are a treatment option for LSS, and 135 of the 164 respondents (82.3%) use them. Poor clinical experience (60%) and lack of evidence (53.9%) are the main reasons cited for not using IPDs. We detected a high negative correlation between the size of the hospital, the number of outpatients and inpatients treated for LSS and other spine pathologies, and the use of IPDs (p = 0.001). Most respondents prefer the combination of open decompression and IPD (64.4%; n = 87). A total of 9.6% (n = 13) of the users favor IPD implantation as a stand-alone procedure. Overall, 25.9%  n = 35  use both options. Most surgeons aim to relieve the facet joints (87.7%) and to stabilize a preexisting instability (75.4%). They recommend IPDs in the segments L2-L3 (77%), L3-L4 (98.5%), and L4-l5 (99.3%) and consider that IPD implanation also could be done at the L5-S1 segment (40.1%). Overall, 64.4% (n = 87) of the users recommend limiting IPD implantation to two segments. Infection (96.3%), fracture (94.8%), isthmic spondylolisthesis (77%), degenerative spondylolisthesis (higher than Meyerding I [57%]), lumbar spine scoliosis (48.1%), and osteoporosis (50.4%) are seen as contraindications for IPD.
  
  
  CONCLUSIONS
  No clear consensus exists among spine surgeons concerning the use of IPD for LSS treatment. The study showed that hospital-related parameters also influence decision making for or against the use of IPDs. However, despite the lack of evidence, the indications and contraindications which had been identified in the present study might contribute to improved outcomes after IPD implantation or at least prevent harm to patients.
authors.affiliation: Department of Orthopaedic and Trauma Surgery, University of Cologne, Cologne, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Siewe
authors.affiliation: Department of Orthopaedic and Trauma Surgery, University of Cologne, Cologne, Germany.
authors.forename: Max
authors.initials: M
authors.lastname: Selbeck
authors.affiliation: Department of Orthopaedic and Trauma Surgery, University of Cologne, Cologne, Germany.
authors.forename: Timmo
authors.initials: T
authors.lastname: Koy
authors.affiliation: Department of Orthopaedic and Trauma Surgery, University of Halle/Saale, Halle/Saale, Germany.
authors.forename: Marc
authors.initials: M
authors.lastname: Röllinghoff
authors.affiliation: Department of Orthopaedic and Trauma Surgery, University of Cologne, Cologne, Germany.
authors.forename: Peer
authors.initials: P
authors.lastname: Eysel
authors.affiliation: Department of Orthopaedic and Trauma Surgery, University of Cologne, Cologne, Germany.
authors.forename: Kourosh
authors.initials: K
authors.lastname: Zarghooni
authors.affiliation: Department of Orthopaedic and Trauma Surgery, University of Cologne, Cologne, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Oppermann
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Medical Center City Aachen GmBH, Würselen, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Herren
authors.affiliation: Department of Orthopaedic and Trauma Surgery, Medical Center City Aachen GmBH, Würselen, Germany.
authors.forename: Rolf
authors.initials: R
authors.lastname: Sobottke
mesh_terms: D019299:Decompression, Surgical / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D016268:Internal Fixators / Q000009:adverse effects / Q000592:standards / Q000706:statistics & numerical data*; D008159:Lumbar Vertebrae / Q000601:surgery*; D019919:Prosthesis Implantation / Q000592:standards / Q000706:statistics & numerical data*; D012042:Registries; D013130:Spinal Stenosis / Q000601:surgery*