Dispositivos interespinosos en discectomías lumbares primarias. ¿Favorecen la recurrencia de la hernia de discos? [Interspinous device in primary lumbar discectomy. Does it favor the recurrence of disc herniation?]

Joint Halley Guimbard Pérez; Mariano Pomba; Gustavo Alejandro González; Nicolás Ortiz

doi:10.15417/issn.1852-7434.2019.84.2.755

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Published: May 2, 2019

DOI: https://doi.org/10.15417/issn.1852-7434.2019.84.2.755

Keywords:

Lumbar discectomy, interspinous spacer, disc herniation recurrence

Joint Halley Guimbard Pérez

Sanatorio Allende, Córdoba, Argentina

http://orcid.org/0000-0002-8887-8947

Mariano Pomba

Hospital Misericordia, Córdoba, Argentina

http://orcid.org/0000-0002-1990-3029

Gustavo Alejandro González

Sanatorio Allende, Córdoba, Argentina

http://orcid.org/0000-0002-3560-108X

Nicolás Ortiz

Sanatorio Allende, Córdoba, Argentina Hospital Misericordia, Córdoba, Argentina

Abstract

Objective: The objective of this study was to evaluate if discectomy with placement of an interspinous silicon DIAM spacer is associated with a different rate of clinical and radiographic ipsilateral disc herniation recurrence than discectomy alone.Methods: A prospective, observational,randomized study was performed from May 2009 to May 2013 at XXXXX. Of the 123 patients included in the study, 3 were lost to follow-up, leaving 120 patients for data analysis. All patients were operated on by the same surgical team. Patients received one of two types of treatment. Group A consisted of 30 patients (16 women and 14 ment) who underwent discectomy with placement of an interspinous silicone DIAM spacer. Group B was composed of 90 patients (53 women and 37 men) who received discectomy alone.Results: Discectomy at L4-L5 was the most common level, occurring in 90% (27) Group A patients and 80% (72) Group B patients. Group A demonstrated clinical and radiographic disc herniation recurrence in 6/30 (20%) of patients. Disc herniation recurrence developed in 4/90 (4.4%) Group B patients. One patient underwent reoperation (1.1%). Both recurrence and reoperation was significantly higher in Group A (p = 0.007 and p = 0.019, respectively).Conclusions: The benefits of interespinosos devices for the treatment of the lumbar spinal stenosis secondary to herniated disc while they are controversial in the present study showed significant difference according to the Group. In this study, patients that underwent discectomy and interspinous spaceer placement had higher reoperation and recurrence rates than discectomy patients that did not receive an interspinous spacer. Interspinous spacers may increase the rate of disc herniation by maintaining movement at the level of prior disc herniation and changing the physiologic load. More studies are needed to corroborate and evaluate these trends.

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How to Cite

Guimbard Pérez, J. H., Pomba, M., González, G. A., & Ortiz, N. (2019). Interspinous device in primary lumbar discectomy. Does it favor the recurrence of disc herniation?. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 84(2), 105-111. https://doi.org/10.15417/issn.1852-7434.2019.84.2.755

Issue

Vol 84 No 2 (2019)

Section

Clinical Research

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Author Biographies

Joint Halley Guimbard Pérez, Sanatorio Allende, Córdoba, Argentina

Servicio de Patología Espinal, Sanatorio Allende, Córdoba, Argentina

Mariano Pomba, Hospital Misericordia, Córdoba, Argentina

Servicio de Ortopedia y Traumatología, Hospital Misericordia, Córdoba, Argentina

Gustavo Alejandro González, Sanatorio Allende, Córdoba, Argentina

Servicio de Patología Espinal, Sanatorio Allende, Córdoba, Argentina

Nicolás Ortiz, Sanatorio Allende, Córdoba, Argentina Hospital Misericordia, Córdoba, Argentina

Jefe del Departamento de Patología Espinal, Sanatorio Allende, Córdoba, ArgentinaStaff Médico Hospital Misericordia, Córdoba, Argentina

References

1. Fandiño J, Botana C, Viladrich A, Gomez-Bueno J. Reoperation after lumbar disc surgery: results in 130 cases. Acta Neurochir Wien 1993;122:102-4. https://doi.org/10.1007/BF01446994

2. Jackson RK. The long-term effects of wide laminectomy for lumbar disc excision: A review of 130 patients. J Bone Joint Surg Br 1971;53:609-16. https://doi.org/10.1302/0301-620X.53B4.609

3. O’Sullivan MG, Connolly AE, Buckley TF. Recurrent lumbar disc protrusion. Br J Neurosurg 1990;4:319-25. https://doi.org/10.3109/02688699008992741

4. Deyo RA, Martin BI, Kreuter W, Jarvik JG, Angier H, Mirza SK. Revision surgery following operations for lumbar stenosis. J Bone Joint Surg Am 2011;93:1979-86. https://doi.org/10.2106/JBJS.J.01292

5. Ciol MA, Deyo RA, Howell E, Kreif S. An assessment of surgery for spinal stenosis: time trends, geographic variations, complications, and reoperations. J Am Soc Geriatr 1996;44:285-90. https://doi.org/10.1111/j.1532-5415.1996.tb00915.x

6. Korovessis P, Repantis T, Zacharatos S, Zafiropoulos A. Does Wallis implant reduce adjacent segment degeneration above lumbosacral instrumented fusion? Eur Spine J 2009;18:830-40. https://doi.org/10.1007/s00586-009-0976-y

7. Lafage V, Gangnet N, Sénégas J, Lavaste F, Skalli W. New interspinous implant evaluation using an in vitro biomechanical study combined with a finite-element analysis. Spine 2007;32:1706-14. https://doi.org/10.1097/BRS.0b013e3180b9f429

8. Strömqvist B, Berg S, Gerdhem P. X-Stop versus decompressive surgery for lumbar neurogenic intermittent claudication: randomized controlled trial with 2-year follow-up. Spine 2013;38(17):1436-42. https://doi.org/10.1097/BRS.0b013e31828ba413

9. Senegas J. Minimally invasive dynamic stabilization of the lumbar motion segment with an interspinous implant. En: Mayer HM (ed.). Minimally invasive spine surgery. Berlin: Springer; 2006, cap. 49. https://doi.org/10.1007/3-540-29490-2_49, Online ISBN 978-3-540-29490-0

10. Kong DS, Kim ES, Eoh W. One-year outcome evaluation after interspinous implantation for degenerative spinal stenosis with segmental instability. J Korean Med Sci 2007; 22:330-5. https://doi.org/10.3346/jkms.2007.22.2.330

11. Kuchta J, Sobottke R, Eysel P, Simons P. Two-year results of interspinous spacer (X-Stop) implantation in 175 patients with neurologic intermittent claudication due to lumbar spinal stenosis. Eur Spine J 2009;18:823-9. https://doi.org/10.1007/s00586-009-0967-z

12. Trautwein FT, Lowery GL, Wharton ND, Hipp JA, Chomiak RJ. Determination of the in vivo posterior loading environment of the Coflex interlaminar-interspinous implant. Spine J 2010;10(3):244-51. https://doi.org/10.1016/j.spinee.2009.10.010

13. Martínez Quiñones JV, Aso J, Consolini F, Arregui R. Long-term outcomes of lumbar microdiscectomy in a working class simple. Neurocirugía (Astur) 2011;22(3):235-44. http://scielo.isciii.es/pdf/neuro/v22n3/clinica3.pdf

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