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Is the interspinous process device safe and effective in elderly patients with lumbar degeneration? A systematic review and meta-analysis of randomized controlled trials – Lumbar Spinal Stenosis

The article is a systematic review and meta-analysis of randomized controlled trials that compares the efficacy and safety of interspinous process device (IPD) treatment to decompression surgery in patients with degenerative lumbar spinal stenosis. The study collected data from five trials involving 555 patients and analyzed outcomes such as Visual Analogue Scale (VAS) scores, Oswestry Disability Index (ODI) scores, and Zurich Claudication Questionnaire (ZCQ) results. The results showed no significant differences in leg pain, back pain, ODI scores, and ZCQ physical function between IPD and decompression surgery. However, decompression surgery was found to be superior in terms of ZCQ symptom severity. There were no advantages for IPD in terms of complications, but it was inferior to decompression surgery in reoperation rate. The study concludes that IPD does not have a clear superiority over decompression surgery, and more clinical studies are needed to determine its efficacy and safety

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : most established spine facility on Harley Street UK

Published article

CONCLUSIONS: This systematic review and meta-analysis indicated no superiority in the clinical outcome for IPD compared with decompression surgery. However, more clinical studies are warranted to determine the efficacy and safety of IPD.

Lumbar Decompression Surgery Expert. Best Spinal Surgeon UK
Eur Spine J. 2024 Feb 12. doi: 10.1007/s00586-023-08119-z. Online ahead of print.ABSTRACTBACKGROUND CONTEXT: Lumbar spinal stenosis is one of the most common diseases affecting the elderly that is characterized by the narrowing of the spinal canal and peripheral neural pathways which may cause back pain and neurogenic intermittent claudication in affected patients. Recently, as an,

Eur Spine J. 2024 Feb 12. doi: 10.1007/s00586-023-08119-z. Online ahead of print.

ABSTRACT

BACKGROUND CONTEXT: Lumbar spinal stenosis is one of the most common diseases affecting the elderly that is characterized by the narrowing of the spinal canal and peripheral neural pathways which may cause back pain and neurogenic intermittent claudication in affected patients. Recently, as an alternative treatment between conservative therapy and decompression surgery, interspinous process device (IPD) such as X-stop, Coflex, DIAM, Aperius, Wallis, etc., has gained enough popularity.

PURPOSE: The purpose of this study was to evaluate the efficacy and safety of IPD in the treatment of degenerative lumbar spinal stenosis compared with decompression surgery.

STUDY DESIGN: This study was a systematic review and meta-analysis of randomized controlled trials.

PATIENT SAMPLE: 555 patients’ samples were collected for this study.

OUTCOME MEASURES: The Visual Analogue Scale and the Oswestry Disability Index were analyzed, as well as the Zurich Claudication Questionnaire For efficacy evaluation. Complication and reoperation rate was utilized for the assessment of safety.

METHODS: A comprehensive literature search was performed through Pubmed, EMBASE, Web of Science, and Cochrane Library until October 2023. Among the studies meeting the eligible criteria, any study in which IPD was utilized in the treatment of degenerative lumbar spinal stenosis was included in the current review. For efficacy evaluation, the Visual Analogue Scale and the Oswestry Disability Index were analyzed, as well as the Zurich Claudication Questionnaire. Complication and reoperation rates were utilized for the assessment of safety.

RESULTS: Five randomized controlled trials with 555 patients were included. There were no significant differences in VAS leg pain (SMD – 0.08, 95% CI – 0.32 to 0.15) and back pain (SMD 0.09, 95%CI-0.27 to 0.45), ODI scores (MD 1.08, 95% CI – 11.23 to 13.39) and ZCQ physical function (MD-0.09, 95% CI-0.22 to 0.05) for IPD compared with decompression surgery. In terms of ZCQ symptom severity (MD – 0.22, 95% CI – 0.27 to – 016), decompression surgery showed superior to the IPD. As for complications (RR 1.08, 95% CI 0.36 to 3.27), the IPD had no advantages compared to decompression surgery, whereas inferior to it in reoperation rate (RR 2.58, 95% CI 1.67 to 3.96).

CONCLUSIONS: This systematic review and meta-analysis indicated no superiority in the clinical outcome for IPD compared with decompression surgery. However, more clinical studies are warranted to determine the efficacy and safety of IPD.

PMID:38342843 | DOI:10.1007/s00586-023-08119-z

The London Spine Unit : most established spine facility on Harley Street UK

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Is the interspinous process device safe and effective in elderly patients with lumbar degeneration? A systematic review and meta-analysis of randomized controlled trials

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Eur Spine J. 2024 Feb 12. doi: 10.1007/s00586-023-08119-z. Online ahead of print.ABSTRACTBACKGROUND CONTEXT: Lumbar spinal stenosis is one of the most common diseases affecting the elderly that is characterized by the narrowing of the spinal canal and peripheral neural pathways which may cause back pain and neurogenic intermittent claudication in affected patients. Recently, as an

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