J Korean Neurosurg Soc.  2012 Oct;52(4):359-364. 10.3340/jkns.2012.52.4.359.

Posterior Interspinous Fusion Device for One-Level Fusion in Degenerative Lumbar Spine Disease : Comparison with Pedicle Screw Fixation - Preliminary Report of at Least One Year Follow Up

Affiliations
  • 1Department of Neurosurgery, Hanyang University College of Medicine, Seoul Hospital, Seoul, Korea. pkh2325@hanyang.ac.kr
  • 2Department of Neurosurgery, Hanyang University College of Medicine, Guri Hospital, Guri, Korea.
  • 3Department of Neurosurgery, Namyangju Woori Hospital, Namyangju, Korea.

Abstract


OBJECTIVE
Transpedicular screw fixation has some disadvantages such as postoperative back pain through wide muscle dissection, long operative time, and cephalad adjacent segmental degeneration (ASD). The purposes of this study are investigation and comparison of radiological and clinical results between interspinous fusion device (IFD) and pedicle screw.
METHODS
From Jan. 2008 to Aug. 2009, 40 patients underwent spinal fusion with IFD combined with posterior lumbar interbody fusion (PLIF). In same study period, 36 patients underwent spinal fusion with pedicle screw fixation as control group. Dynamic lateral radiographs, visual analogue scale (VAS), and Korean version of the Oswestry disability index (K-ODI) scores were evaluated in both groups.
RESULTS
The lumbar spine diseases in the IFD group were as followings; spinal stenosis in 26, degenerative spondylolisthesis in 12, and intervertebral disc herniation in 2. The mean follow up period was 14.24 months (range; 12 to 22 months) in the IFD group and 18.3 months (range; 12 to 28 months) in pedicle screw group. The mean VAS scores was preoperatively 7.16+/-2.1 and 8.03+/-2.3 in the IFD and pedicle screw groups, respectively, and improved postoperatively to 1.3+/-2.9 and 1.2+/-3.2 in 1-year follow ups (p<0.05). The K-ODI was decreased significantly in an equal amount in both groups one year postoperatively (p<0.05). The statistics revealed a higher incidence of ASD in pedicle screw group than the IFD group (p=0.029).
CONCLUSION
Posterior IFD has several advantages over the pedicle screw fixation in terms of skin incision, muscle dissection and short operative time and less intraoperative estimated blood loss. The IFD with PLIF may be a favorable technique to replace the pedicle screw fixation in selective case.

Keyword

Degenerative; Fusion device; Interspinous; Lumbar disease; Posterior; Adjacent segmental degeneration

MeSH Terms

Back Pain
Follow-Up Studies
Humans
Incidence
Intervertebral Disc
Muscles
Operative Time
Skin
Spinal Fusion
Spinal Stenosis
Spine
Spondylolisthesis

Figure

  • Fig. 1 A photograph shows the SPIRE® plate as a posterior interspinous fusion device.

  • Fig. 2 A representative case of a patient with interspinous fusion device. Preoperative axial (A) and sagittal (B) magnetic resonance imaging shows a degenerative lumbar spinal stenosis at L4-5. Postoperative 3-dimensional reconstructed tomographic images (C and D) shows posterior lumbar interbody fusion augmented with the interspinous fusion device.

  • Fig. 3 Graph shows improvement of clinical outcome both in the interspinous fusion device group and pedicle screw group after surgery (p<0.05). A : Visual analogue scale score. B : Korean version of the Oswestry disability index. Preop : preoperation, Postop : postoperation, IFD : interspinous fusion device.

  • Fig. 4 A case of fusion failure and the fracture of articular process after interspinous fusion. Axial (A) and sagittal (B) view of the computed tomography shows the fracture on L4 inferior articular process (black arrow).


Cited by  2 articles

Effect of Device Rigidity and Physiological Loading on Spinal Kinematics after Dynamic Stabilization : An In-Vitro Biomechanical Study
Kwonsoo Chun, Inchul Yang, Namhoon Kim, Dosang Cho
J Korean Neurosurg Soc. 2015;58(5):412-418.    doi: 10.3340/jkns.2015.58.5.412.

Biomechanical Comparison of Spinal Fusion Methods Using Interspinous Process Compressor and Pedicle Screw Fixation System Based on Finite Element Method
Jisoo Choi, Sohee Kim, Dong-Ah Shin
J Korean Neurosurg Soc. 2016;59(2):91-97.    doi: 10.3340/jkns.2016.59.2.91.


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