Interspinous process device vs surgical decompression for lumbar spinal stenosis

A study compares the effectiveness and safety of interspinous process devices against conventional surgical decompression for lumbar spinal stenosis.

Read the full research online: bmj.com/content/347/bmj.f6415 Recent developments in spinal surgery implants promise less invasive procedures with superior effectiveness to conventional surgery. Particularly in (older) patients with spinal stenosis due to arthrosis of the facet joints, implantation of an interspinous process device is regularly offered. However, the growing incidence of low back surgery with additional implants for degenerative spine disease has raised questions from the scientific community. Furthermore, the economic burden of management of lumbar spine disorders (lumbar spinal disorder and lumbar disc disease combined) was already worrisome in the 1990s, when they ranked fifth on the basis of cost of hospital care. The increasing use of implants, combined with a growing older population, leads to societal concerns as the cost of the management of spinal stenosis is escalating. In this double blind randomised control trial, the researchers from The Netherlands set out to assess whether interspinous process device implantation is more effective in the short term than conventional surgical decompression for patients with intermittent neurogenic claudication due to lumbar spinal stenosis. The primary outcome at short term (eight weeks) and long term (one year) follow-up was the Zurich Claudication Questionnaire score. Repeated measurements were made to compare outcomes over time. They conclude that their double blinded study could not confirm the hypothesized short term advantage of interspinous process device over conventional "simple" decompression and even showed a fairly high reoperation rate after interspinous process device implantation.