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Indirect decompression for spinal stenosis similar to decompressive laminectomy

However, study finds indirect compression devices may correlate to higher secondary surgery rate.

Issue: January 2008

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AUSTIN, Texas — Early results on indirect decompression indicate comparable quality of life and function to conventional decompressive surgery for patients with lumbar spinal claudication. However, the procedure may lead to more reoperations.

In a prospective randomized study, Swedish investigators compared 50 patients who underwent indirect decompression using the X-Stop IPD implant (Kyphon) and 50 patients who had conventional decompression for lumbar spinal claudication. While they discovered that both groups showed significant improvement over baseline scores, they found no significant differences between the cohorts regarding mean Visual Analog Scale (VAS) scores for pain, Physical Component Summary (PCS) scores of the Short Form-36 (SF-36) and components of the Zürich Spinal Stenosis Questionnaire for symptom severity and physical function at six, 12 and 24-months follow-up. However, the ongoing study revealed 14 cases of reoperation in the X-Stop group compared to four cases in the decompression cohort.

‘Low complication rate’

“You can say that there is a low complication rate for lumbar spinal claudication,” Björn Strömqvist, MD, PhD, said during his presentation at the North American Spine Society 22nd Annual Meeting. “X-stop seems to be a valid alternative to decompression, but it also yields more secondary operations. However, he noted that the study had short-term follow-up and that more definitive results would be available in 1 to 2 years.

The study included 100 patients with spinal claudication and MRI verification of stenosis at one to two levels. The patients had a mean age of 70 years and were treated at three Swedish spine centers. The investigators randomized the patients to receive conventional decompression or indirect decompressive surgery using envelopes.

They completed 6-month follow-up on 80 patients and 12-month follow-up on 62 patients. Thirty-nine patients reached 24-month follow-up.

Reoperation rates

The study revealed two deaths at more than 1-year postop and one case of spinous process fracture. The investigators also found 14 cases of reoperation in the X-Stop-treated patients and four cases in the direct decompression group.

Of the three centers involved in the study, Strömqvist noted that one center had more cases of reoperation for X-Stop-treated patients (eight of 11 cases). The other centers noted only four reoperation cases out of 25 indirect decompressive surgeries and just two reoperations out of 14 indirect decompressive cases.

For more information:

• Björn Strömqvist, MD, PhD, can be reached at Department of Orthopedics, Lund University Hospital, SE-22185 Lund, Sweden. +46-46-17-15-00; e-mail: bjorn.stromqvist@ort.lu.se. He has no direct financial interest in any products or companies mentioned in this article.

Reference:

• Strömqvist B, Berg S, Gerdhem, et al. Indirect decompression (X-Stop) versus conventional decompressive surgery for lumbar spinal claudication — A prospective randomized trial. Paper #146. Presented at the North American Spine Society 22nd Annual Meeting. Oct. 23-27, 2007. Austin, Texas.