Cowan MD The patient is a year-old female with a 5-year history of severe low back pain. During the last 3 years her pain is worse. She describes her lower lumbar pain as constant and refractory to all treatments. Geriatric patient, past laminectomy Presented by: R.
|Published (Last):||23 April 2011|
|PDF File Size:||15.21 Mb|
|ePub File Size:||1.55 Mb|
|Price:||Free* [*Free Regsitration Required]|
Yorg View at Google Scholar D. Indexed in Science Citation Index Expanded. In the s, several other IDP techniue displaying significant differences in design, materials, surgical techniques, and indications appeared in Europe and South America, for which there are ongoing trials of evaluation for a host of clinical indications. Any neuromuscular deficit which places an unusually heavy load on techinque device during the healing period.
These considerations are applicable with different types of interspinous spinous devices with only few differences between the distinct categories. In a reported prospective trial, the application of the first generation Wallis device improved outcome in patients who underwent a second discectomy. The components are used to build a construct to provide stabilization of spinal segments in the thoracic, lumbar and sacral spine to support fusion.
It has been reported recently [ 66 ] in a health economical analysis that considerable healthcare cost savings can be obtained using an IPD on an outpatient basis. This material is intended for health care professionals.
The authors requested further biomechanical and clinical evidence to strongly support the recommendation of a stand-alone interspinous fusion device or as supplemental fixation to expandable posterior interbody cages [ 58 ].
In the first generation of the device, the wing clamps could be attached to the spinous processes by a suture passed through the central hole. Standard Implant For Aspen Standard, the tedhnique barrel is 21mm long and may be best suited for a thick spinous process Medium Implant With a medial-lateral dimension that is 3mm shorter in the barrel, the Aspen Medium implant may be preferred.
An overweight or obese patient can produce loads on the spinal system, which can lead to failure of the fixation of the device or failure of the device itself. Anderson reported two years outcome in patients whose symptoms were due to degenerative spondylolisthesis at one or two levels; using ZCQ and SF questionnaire, Interspinous fusion devices contrast with interspinous distraction devices also called spacers ; the latter are used alone for decompression and may not be fixed to the spinous processes.
Abstract A large number of interspinous process devices IPD have been recently introduced to the lumbar spine market as surgicsl alternative to conventional decompressive surgery in yechnique symptomatic lumbar spinal pathology, especially in the older population. It is asppen of a self-distracting helical tip Figure We listed the most important devices that are still on the market Table 1.
View at Google Scholar O. Although the initial reports represented the IPD as a safe, effective, and minimally tevhnique surgical alternative for relief of neurological symptoms in patients with low back degenerative diseases, recent studies have demonstrated less impressive clinical results and higher rate of failure than initially reported. Various authors suggest that advantages of IPD compared with standard surgical decompression techniques are the option of local anesthesia, aapen of bone and soft tissue, reduced risk of epidural scarring and cerebrospinal fluid leakage, with a shorter hospital stay and rehabilitation period, and reversibility of the surgical procedure that does not limit future surgical treatment options [ 39 — 46 ].
View at Google Scholar V. Signs of local infection or inflammation. The correct implant size is indicated on the sizing instrument and the appropriately sized X-Stop implant is inserted between the spinous process.
But in this paper, the beneficial outcomes reported were misleading inflated and, in addition, laxn was a conflict of interest for the two primary authors. Letter to the Editor. The appropriate sized interspinous device is chosen and placed between the spinous processes and squeezed together, and the device is compressed or distract with an appropriate device.
The first interspinous implant for the lumbar spine was developed in the s by Knowles. The spacer has a distal and proximal 10 degrees inclined groove to better house the spinous processes and adapt to the anatomy of the spinous processes. More recently, Bowers et al. Senility, mental illness or substance abuse, of a severity that the patient may ignore certain necessary limitations and precautions in the use of the implant, leading to failure or other complications.
The two lateral wings lajx migration texhnique or laterally, and the supraspinous ligament prevents the implant from migrating posteriorly. In another report, published by the same authors, the X-Stop group showed improvements in physical and mental component scores Quality of life SF compared to both baseline and control patients. The Helifix Interspinous Spacer System is a percutaneous self-distracting implant manufactured from PEEK polyetheretherketone material and tantalum radiographic markers.
BioMed Research International Removal is indicated because the implants are not intended to transfer or support forces developed during normal activities. Reuse of the implant components may result in reduced mechanical performance, malfunction, or failure of the device. Enlargement of the Spinal Canal Area A decisive index for the relief of the clinical signs and symptoms is the enlargement spinal canal area.
The Posterior Fusion System is a titanium implant that has an adjustable, fenestrated core and adjustable-length plates which allows for expansion and compression.
Nevertheless, the biomechanical mechanism is not clear, because both compression and distraction cause a significant decrease in nucleus pressure; however, the compression results in a greater pressure decrease than distraction. The surgeon must be fully conversant with all aspects of the surgical technique and know the indications and contra-indications of this type of implant.
A large number of interspinous process devices IPD have been recently introduced to the lumbar spine market as an alternative to conventional decompressive surgery in managing symptomatic lumbar spinal pathology, especially in the older population.
The IDE investigational device exemption trial for the Coflex was a randomized multicenter noninferiority study that compared Coflex implantation with decompression and posterolateral fusion with pedicle screw fixation [ 64 ]. The posterior Fusion device consists of spinous process plates made of Titanium Alloy and commercially pure titanium Figure While the rationale of their use in the treatment of spinal stenosis is clear, the role in the treatment of degenerative disc disease remains to be defined.
They suggested that laminectomy was the most effective treatment strategy, followed by X-Stop and then conservative treatment at a 2-year time horizon [ 67 ]. The insertion of increasing size trocars allows for a gradual distraction of the interspinous area to measure the optimal decompression and prevent overdistraction.
TOP Related Posts.
LANX ASPEN SURGICAL TECHNIQUE PDF
View at Google Scholar D. The purpose of this paper is to provide a comprehensive overview on interspinous implants, their mechanisms of action, safety, cost, and effectiveness in the treatment of lumbar stenosis and degenerative disc diseases. The Aspen system can be used with or without bone grafting. Senility, mental illness or substance abuse, of a severity that the patient may ignore certain necessary limitations and precautions in the use sjrgical the implant, leading to failure or other complications. The surgeon must have acquainted himself before the operation with the specific technique for insertion of the product, which is available from the manufacturer.
Aspen™ Spinous Process Fixation System
The percentage of adverse events was 5. Based on these data, a severely osteoporotic patient may be contraindicated for interspinous device, because a fracture of the spinous process might occur intraoperatively or postoperatively. BioMed Research International These considerations are applicable with different types of interspinous spinous devices with only few differences between the distinct categories. After removing the latter dilator, the sizing distractor is inserted and the interspinous space is distracted until the supraspinous ligament becomes taught.