NITINOL INTERSPINOUS DISTRACTION DEVICE IN SURGICAL TREATMENT OF SEGMENTAL INSTABILITY OF THE LUMBAR SPINE
Abstract
Objective. To specify indications for application of interspinous spacers and to analyze results of surgical treatment of instability of the lumbar motion segment using dynamic interspinous stabilization.
Material and Methods. A total of 15 patients (5 males and 10 females, mean age 46 years) with instability of the lumbar spine were operated on with insertion of the authoring nitinol interspinous distraction device. Surgical treatment was performed for the instability of the lumbar spine. Postoperative follow-up at 6 and 12 months included orthopedic and neurologic examination, functional spondylography, and questionnaire survey of patients.
Results. Analysis of 6- and 12-month follow-up results showed statistically significant improvement in VAS, Oswestry, and SF-36 scores. The X-ray examination showed that the spacer installation preserved both the segmental motion and the intervertebral disc height. The obtained data testify to the comparability of application results of the authoring distraction device with those of other interspinous spacers.
Conclusion. The main indications for the use of interspinous distraction device are segmental instability, as well as prevention of secondary pathologic mobility in the operated spinal motion segment. Nitinol interspinous distraction device allows for elimination of segmental instability while preserving physiological range of motion.
About the Authors
Evgeny Aleksandrovich Davydov
Professor Polenov Russian Neurosurgical Research Institute, St. Petersburg
Russian Federation
Russian Federation
Aleksandr Sergeyevich Nazarov
Professor Polenov Russian Neurosurgical Research Institute, St. Petersburg
Russian Federation
Russian Federation
Oleg Nikolayevich Tyulkin
Professor Polenov Russian Neurosurgical Research Institute, St. Petersburg
Russian Federation
Russian Federation
Aleksandr Anatolyevich Ilyin
Russian State Technologic University n.a. K.E. Tsiolkovsky, Moscow
Russian Federation
Russian Federation
Mikhail Yuryevich Kollerov
Russian State Technologic University n.a. K.E. Tsiolkovsky, Moscow
Russian Federation
Russian Federation
References
1. Вознесенская Т.Г. Боли в спине и конечностях // Болевые синдромы в неврологической практике / Под ред. А.М. Вейна и др. М., 1999. С. 217-283.
2. Ильин А.А., Коллеров М.Ю., Давыдов Е.А. Устройство для дистракции остистых отростков. Патент № 2453289. Дата подачи заявки 12.11.2010; дата публ. 20.06.2012, бюл. 17.
3. Коновалов Н.А. Прогнозирование микрохирургического лечения межпозвонковых дисков на пояснично-крестцовом уровне: Автореф. дис.. канд. мед. наук. М., 1999.
4. Левченко С.К. Экспериментально-клиническое обоснование функциональной транспедикулярной стабилизации позвоночника: Дис.. канд. мед. наук. М., 2004.
5. Маркин С.П. Задняя динамическая фиксация в хирургическом лечении поясничного остеохондроза: Дис.. канд. мед. наук. Новосибирск, 2010.
6. Миронов С.П., Ветрилэ С.Т., Ветрилэ М.С. и др. Оперативное лечение спондилолистеза позвонка L5 с применением транспедикулярных фиксаторов // Хирургия позвоночника. 2004. № 1. С. 39-46.
7. Панаськов А.В. Нестабильность позвоночника при поясничном остеохондрозе: Дис.. канд. мед. наук. СПб., 2003.
8. Романенков В.М., Самошенков А.Г. Отдаленные результаты хирургического лечения грыж межпозвонковых дисков поясничного отдела позвоночника // III съезд нейрохирургов России: Мат-лы. СПб., 2002. С. 275-276.
9. Сидоров Е.В. Клиника, диагностика и хирургическое лечение стеноза поясничного отдела позвоночного канала: Автореф. дис.. канд. мед. наук. М., 2003.
10. Симонович А.Е. Хирургическое лечение дегенеративных поражений поясничного отдела позвоночника: Дис.. д-ра мед. наук. Новосибирск, 2005.
11. Biering-Sorensen F. Low back trouble in a general population of 30-, 40-, 50-, and 60-year-old men and women: Study design, representativeness and basic results. Dan Med Bull. 1982; 29: 289-299.
12. Bridwell, KH, Sedgewick TA, O’Brien MF, et al. The role of fusion and instrumentation in the treatment of degenerative spondylolisthesis with spinal stenosis. J Spinal Disord. 1993; 6: 461-467.
13. Cauchoix J, Ficat C, Girard B. Repeat surgery after disc excision. Spine. 1978; 3: 256-259.
14. Christie SD, Song JK, Fessler RG. Dynamic interspinous process technology. Spine. 2005; 30( 16 Suppl): S73-S78.
15. Dillingham T. Evaluation and management of low back pain: an overview. State Art Rev. 1995; 9: 559-574.
16. Fischgrund JS, Mackay M, Herkowitz HN, et al. 1997 Volvo Award winner in clinical studies. Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective, randomized study comparing decompressive laminectomy and arthrodesis with and without spinal instrumentation. Spine. 1997; 22: 2807-2812.
17. Friberg O. Lumbar instability: a dynamic approach by traction-compression radiography. Spine. 1987; 12: 119-129.
18. Fritsch EW, Heisel J, Rupp S. The failed back surgery syndrome: reasons, intraoperative findings, and long-term results: a report of 182 operative treatments. Spine. 1996; 21: 626-633.
19. Fritzell P, Hagg O, Wessberg P, et al. Chronic low back pain and fusion: a comparison of three surgical techniques: a prospective multicenter randomized study from Swedish lumbar spine study group. Spine. 2002; 27: 1131-1141.
20. Hides J, Richardson C, Jull GA. Multifidus recovery is not automatic following resolution of acute first-episode low back pain. Spine. 1996; 21: 2763-2769.
21. Indahl A, Velund L, Reikeraas O. Good prognosis for low back pain when left untampered. Spine. 1995; 20: 473-477.
22. Jonsson B, Stromqvist B. Clinical characteristics of recurrent sciatica after lumbar discectomy. Spine. 1996; 21: 500-505.
23. Kotilainen E. Long-term outcome of patients suffering from clinical instability after microsurgical treatment of lumbar disc herniation. Acta Neurochir (Wien). 1998; 140: 120-125.
24. Kotilainen E, Valtonen S. Clinical instability of the lumbar spine after microdiscectomy. Acta Neurochir (Wien). 1993; 125: 120-126.
25. Long DM, BenDebba M, Torgenson WS, et al. Persistent back pain and sciatica in the United States: patient characteristics. J Spinal Disord. 1996; 9: 40-58.
26. Lonstein JE, Denis F, Perra JH, et al. Complications associated with pedicle screws. J Bone Joint Surg Am. 1999; 81: 1519-1528.
27. Mascarenhas AA, Thomas I, Sharma G, et al. Clinical and radiological instability following standard fenestration discectomy. Indian J Orthop. 2009; 43: 347-351. doi: 10.4103/0019-5413.55465
28. Masferrer R, Gomez CH, Karahalios DG, et al. Efficacy of pedicle screw fixation in the treatment of spinal instability and failed back surgery: a 5-year review. J Neurosurg. 1998; 89: 371-377.
29. Nagi SZ, Riley LE, Newby LG. A social epidemiology of back pain in a general population. J Chron Dis. 1973; 26: 769-779.
30. Panjabi MM. Clinical spinal instability and low back pain. J Electromyogr Kinesiol. 2003; 13: 371-379.
31. Park P, Garton HJ, Gala VC, et al. Adjacent segment disease after lumbar or lumbosacral fusion: review of the literature. Spine. 2004; 29: 1938-1944.
32. Pope MH, Panjabi M. Biomechanical definition of spinal instability. Spine. 1985; 10: 255-256.
33. Swanson KE, Lindsey DP, Hsu KY, et al. The effects of an interspinous implant on intervertebral disc pressures. Spine. 2003; 28: 26-32.
34. Weiler PJ, King GJ, Gertzbein SD. Analysis of sagittal plane instability of the lumbar spine in vivo. Spine. 1990; 15: 1300-1306.
35. White AA, Panjabi MM. Clinical Biomechanics of the Spine. 2nd ed. Philadelphia: JB Lippincott, 1990. 752 p.
Review
For citations:
Davydov E.A., Nazarov A.S., Tyulkin O.N., Ilyin A.A., Kollerov M.Yu. NITINOL INTERSPINOUS DISTRACTION DEVICE IN SURGICAL TREATMENT OF SEGMENTAL INSTABILITY OF THE LUMBAR SPINE. Russian Journal of Spine Surgery (Khirurgiya Pozvonochnika). 2015;12(1):76-82. (In Russ.)
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