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INTRODUCTION OF A SECOND PERCUTANEOUS INTERSPINOUS DEVICE AT THE SAME LEVEL IN CASE OF FORMER FAILURE: TWO IS BETTER THAN ONE? 2012

Interventional Spine

Luigi, Manfre, MD

Poster

Purpose

Percutaneous application of interspinous process spacers (IPS) has become a powerful technique resolving symptoms in patients affected by foramina or lumbar canal stenosis. However, 3% to 6% of failure has been described in the literature, generally related to osteoporotic bone and laminae remodeling, reducing the space between the posterior arches and restoring the symptoms. We evaluate the possibility to strength the posterior arch by performing PMMA augmentation before introducing a second IPS.

Methods & Materials

112 patients affected by lumbar canal or foramina stenosis underwent percutaneous CTguided IPS application (82 at L4-L5 level, 30 at L3/L4 one). Among them, 8/112 patients come back in 1 to 6 months complaining about restoring original symptoms. CT scan demonstrated remodeling of the laminae. We performed a CTguided vertebral augmentation of the posterior arches (1cc to 3cc of PMMA) involved in the former IPS introduction, and 2 weeks later a new IPS was put behind (6 cases) or in front of (2 cases) the first one.

Results

In all the patients no complications were observed after posterior arch (laminae & spinous process) augmentation. All the patients resolved the symptoms after the second IPS introduction, as well as restoring the correct spinal canal & foramina diameter.

Conclusion

Posterior arch augmentation in patients with a former IPS and the subsequent introduction of a second IPS device at the same level seems to be a safe technique in patients with failure of IPS introduction.

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