Perspective: Efficacy and outcomes for different lumbar interspinous devices (ISD) vs. open surgery to treat lumbar spinal stenosis (LSS)

Nancy E Epstein; Marc A Agulnick

doi:10.25259/SNI_1007_2023

Perspective: Efficacy and outcomes for different lumbar interspinous devices (ISD) vs. open surgery to treat lumbar spinal stenosis (LSS)

Surg Neurol Int. 2024 Jan 19:15:17. doi: 10.25259/SNI_1007_2023. eCollection 2024.

Authors

Nancy E Epstein¹, Marc A Agulnick²

Affiliations

¹ Professor of Clinical Neurosurgery, School of Medicine, State University of NY at Stony Brook, c/o Dr. Marc Agulnick, 1122 Franklin Avenue Suite 106, Garden City, NY, USA.
² Assistant Clinical Professor of Orthopedics, NYU Langone Hospital, Long Island, NY, USA, 1122 Frankling Avenue Suite 106, Garden City, NY, USA.

Abstract

Background: Interspinous devices (ISD) constitute a minimally invasive (MI) alternative to open surgery (i.e., laminectomy/decompression with/without fusion (i.e., posterior lumbar interbody fusion (PLIF)/posterolateral instrumented fusion (PLF)) for treating lumbar spinal stenosis (LSS). Biomechanically, static and/or dynamic ISD "offload" pressure on the disc space, increase intervertebral foraminal/disc space heights, reverse/preserve lordosis, limit range of motion (ROM)/stabilize the surgical level, and reduce adjacent segment disease (ASD). Other benefits reported in the literature included; reduced operative time (OR Time), length of hospital stay (LOS), estimated blood loss (EBL), and improved outcomes (i.e., ODI (Oswestry Disability Index), VAS (Visual Analog Scale), and/or SF-36 (Short-Form 36)).

Methods: Various studies documented the relative efficacy and outcomes of original (i.e., Wallis), current (i.e., X-STOP, Wallis, DIAM, Aperius PercLID), and new generation (i.e., Coflex, Superion Helifix, In-Space) ISD used to treat LSS vs. open surgery.

Results: Although ISD overall resulted in comparable or improved outcomes vs. open surgery, the newer generation ISD provided the greatest reductions in critical cost-saving parameters (i.e., OR time, LOS, and lower reoperation rates of 3.7% for Coflex vs. 11.1% for original/current ISD) vs. original/current ISD and open surgery. Further, the 5-year postoperative study showed the average cost of new generation Coflex ISD/decompressions was $15,182, or $11,681 lower than the average $26,863 amount for PLF.

Conclusion: Patients undergoing new generation ISD for LSS exhibited comparable or better outcomes, but greater reductions in OR times, EBL, LOS, ROM, and ASD vs. those receiving original/current ISD or undergoing open surgery.

Keywords: Adverse Events; Coflex; Complications; Decompression; Dynamic; Interspinous Devices (ISD); Laminectomy; Lumbar Spinal Stenosis (LSS); Open Surgery; Outcomes; Posterior Lumbar Interbody Fusion (PLIF); Posterolateral Fusion (PLF); Static; X-Stop.

Publication types

Review