title: Posterior Arch Augmentation (Spinoplasty) before and after Single and Double Interspinous Spacer Introduction at the Same Level: Preventing and Treating the Failure?
abstract: Lumbar spinal canal stenosis (LSCS) is one of the most common degenerative diseases in elderly patients. Failure of he treatment can occur, generally related to bone remodelling/fracture of spinous processes. PMMA augmentation of the posterior arch (spinoplasty, SP) has recently been proposed in case of neoplastic involvement. This study evaluated the efficacy of SP as a prophylactic treatment before introducing an interspinous spacer (IS). Moreover, we consider the possibility to treat patients who previously underwent IS implants with subsequent failure of the device, by introducing a second spacer at the same level, performing accessory SP. From January 2009 to September 2011, 174 patients with LSCS underwent CT-guided percutaneous IS implant in our department. From January 2011, all patients with osteoporosis underwent prophylactic SP before introducing the spacer. Moreover, in patients with re-stenosis related to bone remodelling and/or fracture, after strengthening the spinous processes with PMMA introduction, a second similar device was introduced to re-open the stenotic spinal canal. In patients with prophylactic treatment before spacer introduction, no restenosis occurred at three to 12 month follow-up. Patients who underwent second spacer implant at the same level after posterior arch augmentation again obtained a resolution of symptoms, and no further bone remodelling had occurred at follow-up controls. In conclusion, prophylactic SP prevents single spacer failure for bone remodelling/fracture, and allows failure repair by introducing a second spacer at the same level.
authors.affiliation: Department of Minimal Invasive Spine Therapy, Cannizzaro Hospital; Catania, Italy - lmanfre@me.com.
authors.forename: Luigi
authors.initials: L
authors.lastname: Manfré
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001843:Bone Cements; D016723:Bone Remodeling; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016268:Internal Fixators; D017116:Low Back Pain / Q000209:etiology / Q000601:surgery; D008161:Lumbosacral Region / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D010024:Osteoporosis / Q000150:complications; D010147:Pain Measurement; D019904:Polymethyl Methacrylate; D011183:Postoperative Complications / Q000453:epidemiology; D012008:Recurrence; D013130:Spinal Stenosis / Q000601:surgery*; D025321:Surgery, Computer-Assisted; D016896:Treatment Outcome
chemical_list: D001843:Bone Cements; D019904:Polymethyl Methacrylate
keywords: lumbar canal stenosis; prophylaxis; spacer; spine