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IIIRD GENERATION CTGUIDED PERCUTANEOUS INTERSPINOUS DISTRACTOR IN SCIATICA RELATED TO FORAMINA STENOSIS: NEW APPLICATION. 2012

Interventional Spine

Luigi, Manfre, MD

Paper/Non-Mentor

Purpose

Lumbar foraminal stenosis is generally related to degenerative discal disease, with reduction of the size of the foramina and subsequent spinal nerve compression. Conventional surgical treatment of foraminal stenosis can be affected by several side effects. Recently, CTguided percutaneous interspinous devices (ISD) have been used in patients affected by spinal canal stenosis related to yellow ligaments bulging and nerve compression.

Methods & Materials

Among 154 patients treated from 2008 with ISD, we selected 5 patients with severe lateral foramina stenosis, severe selected nerve compression, positive EMG study for involvement of the nerve inside the narrowed foramen, and compatible symptoms (i.e. radicular pain, numbness, paresthesia). The width of the foramen (anteroposterior AP and caudocranial CC distance) was calculated on 2D reconstructed CT images before and after the ISD introduction. The pain of the patients was evaluates according to a VAS scale

Results

After the treatment, the mean width of the pathologic foramen increased of 8mm, with appreciated increase of AP and CC measurements. At one week and three months follow-up, all the patients referred disappearance of previous reported monoradicular pain and, in the case with L5 dependent paresys, restitutio-ad-integrum was apprecciated immediately after the decompression.

Conclusion

Percutaneous CTguided ISD treatment seems to be useful in patients with symptomatic neural foramen stenosis related to disc degenerative disease and reduced distance between articular facets.

References/Financial Disclosures

Ryan D. Murtagh, Robert M. Quencer, Antonio E. Castellvi, and James J. Yue New Techniques in Lumbar Spinal Instrumentation: What the Radiologist Needs to Know Radiology, August 2011; 260: 317 - 330. Simon Robinson, James Fountain, and Bruce Pennis RETROSPECTIVE COHORT STUDY COMPARING OPEN DECOMPRESSION AND INTERSPINOUS DEVICE INSERTION FOR LUMBAR SPINAL STENOSIS J Bone Joint Surg Br Proceedings, May 2011; 93-B: 192 - 193. THE EARLY CLINICAL OUTCOME OF A CONSECUTIVE SERIES OF INTERSPINOUS DISTRACTION DEVICES J Bone Joint Surg Br Proceedings, Jul 2010; 92-B: 380.

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