Original Article

Aperius® interspinous spacer vs open surgery in degenerative lumbar spinal stenosis

P Menchetti, F Postachini

Citation

P Menchetti, F Postachini. Aperius® interspinous spacer vs open surgery in degenerative lumbar spinal stenosis. The Internet Journal of Minimally Invasive Spinal Technology. 2008 Volume 3 Number 4.

Abstract

In the latest years several Interspinous spacers have been created and employed in degenerative lumbar spinal stenosis (DLSS) treatment, both percutaneously (Aperius, Superion, In-Space) and via mini open (X-Stop). At the moment the real efficacy of these devices, particularly about the percutanously ones, it is not completely clear and has not been fully investigated regarding indications, anatomic and biomechanical effects and results. From the above considerations, the purpose of our study is to evaluate the results of the Aperius™ PercLID™ (Medtronic) interspinous spacer versus open surgery in DLSS treatment, and to define the surgical indications and biomechanical/anatomic effect related.MATHERIALS AND METHODS: Two different groups of patients affected by DLSS have been analyzed: in Group I of 30 patient the Aperius™ PercLID™ has been implanted; in Group II open surgery (with or without the use of microscope) open surgery has been performed. In Group I there were 14 males and 14 females, the average age was 72 years and in 2 patients a spondilolysthesis < 25% was present. In 20 cases the interspinous spacer have been implanted on L4-L5, in 3 cases on both L3-L4, L4-L5, and in the other ones on L3-L4. No preoperative motor deficit was present. In most of cases a 12mm diameter has been implanted. The average follow-up was of 8.2 months (6-14). In Group II there were 13 males and 17 females, the average age was 67 years, operated in the last 3 years. In 3 patients a degenerative spondilolysthesis was present, but no arthrodesis has been performed. The most involved anatomic level was L4-L5 and then L3-L4. In four patients a preoperative motor deficit was present. The following procedures have been performed: unilateral laminotomy, bilateral laminotomy at 1 or more levels, bilateral decompression with unilateral approach, bilateral laminectomy.The average follow-up in Group I was 8.2 months (6-14), in Group II 1.4 years (8 months-2.6 years). Clinical evaluation at follow-up included VAS, ODI and has been performed by two physicians not involved in ths surgical treatments. Related to preoperative MRI or CT-Scan, DLSS has been divided in four categories: mild, moderate, severe and very severe.RESULTS: In Group I, 25 patients (83%) improved radicular pain, and 5 patients (17%) had a poor result; in 2 of the poor results, a degenerative spondilolysthesis was present, and after the interspinous spacer removal, a decompression associated to arthrodesis has been performed. VAS improved after surgery from 20 to 73 and ODI from 63 to 11. In most of patients DLSS was mild or moderate. In Group II, 26 patients (87%) improved, and 4 (13%) had a poor result. VAS improved from 16 a 82 and ODI from 69 a 12. All patients presented important DLSS from moderate to very severe.CONCLUSIONS: No statistically significant difference has been found, even if better results were due to open surgery. However in the Aperius Group, most of patients presented a mild or moderate DLSS, while in the open surgery Group DLSS was moderate or very severe. From the above considerations and results, Aperius™ Perc LID™ interspinous spacer is particularly indicated in patients with “soft” stenosis with hypertrophied ligamentum flavum enfolding posteriorly. In conclusion the poor results in Aperius group are related to wrong patient selection.

 

References

Author Information

P. Menchetti, M.D., FRCS (US)
Orthopaedics Department, “Sapienza” University

F. Postachini, Prof.Dr.med.
Universita d Firenze

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