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PERCUTANEOUS TREATMENT OF LUMBAR COMPRESSION FRACTURE WITH CANAL STENOSIS AND NEUROGENIC INTERMITTENT CLAUDICATION COMBINING KYPHOPLASTY AND INTERSPINOUS SPACER 2012

Interventional Spine

Giuseppe, Bonaldi, M.D.
Alessandro, Cianfoni, Prof., Non ASSR Member

Paper/Non-Mentor

Purpose

To demonstrate effectiveness of a percutaneous treatment of vertebral compression fractures characterized by retropulsion of the posterior-superior corner of the collapsed body.

Methods & Materials

We observed 4 patients with a single vertebral body collapse of osteoporotic origin, in whom also the cauda equina roots were compressed by intracanalar bony fragment dislodgement. Patients complained of back pain and intermittent neurogenic claudication. The treatment combined a standard balloon kyphoplasty followed by percutaneous implant of the Aperius interspinous spacer, in 2 cases concurrently, in 2 in separate surgical sessions.

Results

All patients had a very favorable clinical result on both back pain and INC symptoms. Such results remain stable at 36, 32, 18, 12 month follow-ups. Three patients underwent a MR control at 36, 32, 12 months after implant of the interspinous spacer. In two cases a persistent reduction of the pre-operative spinal canal stenosis was depicted, in one case MRI did not show any modification in size of the spinal canal despite the favorable clinical result.

Conclusion

The cases we are presenting confirm that the combination of kyphoplasty and percutaneous interspinous spacer device implant may be a safe, easy to perform, efficient option in fragile patients. The two procedures, thanks to the very low invasiveness of both, can be separated, if deemed safer, and interspinous spacer implant may be performed only if favorable clinical results are not obtained by kyphoplasty alone. Osteoporotic and elderly patients are fragile, and surgery must be proposed only when inevitable. To our knowledge, this is the first description of a totally percutaneous approach to such pathologic conditions.

References/Financial Disclosures

- Arbit E, Pannullo S. Lumbar stenosis: a clinical review. Clin Orthop 2001;384:137-143. - Katz JN, Harris MB. Lumbar spinal stenosis. N Engl J Med 2008;358:818-825. - Kondrashov DG, Hannibal M, Hsu KY, Zucherman JF. Interspinous process decompression with the X-STOP. Device for lumbar spinal stenosis. A 4-Year follow-up study. J Spinal Disord Tech. 2006;19:323-327. - Zucherman JF, Hsu KY, Hartjen CA, Mehalic, TF, Implicito, DA, Martin MJ, et al. A multicenter, prospective, randomized trial evaluating the X STOP interspinous process decompression system for the treatment of neurogenic intermittent claudication. Two-Year follow-up results. Spine.2005;30(12):1351-1358. - Richards JC, Majumdar S, Lindsey DP, Beaupré, GS, Yerby SA. The treatment mechanism of an interspinous process implant for lumbar neurogenic intermittent claudication. Spine.2005; 30:744-749. - Siddiqui M, Nicol M, Karadimas E, Smith F, Wardlaw D. The positional magnetic resonance imaging changes in the lumbar spine following insertion of a novel interspinous process distraction device. Spine. 2005;30:2677-2682. - Siddiqui M, Nicol M, Karadimas E, Smith F, Wardlaw D. Influence of x stop on neural foramina and spinal canal area in spinal stenosis. Spine.2006;31:2958-2962. No disclosure.

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