Editorial. Interspinous spacers for lumbar stenosis: time for obsolescence?
2021; Volume: 34; Issue: 4 Linguagem: Inglês
10.3171/2020.8.spine201205
ISSN1547-5654
AutoresMarjorie C. Wang, Mohammed Y. T. AlGhamdi,
Tópico(s)Spinal Fractures and Fixation Techniques
Resumoumbar spinal stenosis (LSS) is the most common indication for spine surgery in the elderly population.This condition is prevalent in approximately 47% of 60-to 69-year-old individuals and increases with age. 1 In the US, rates of surgery for LSS have rapidly increased over time. 2 Although open laminectomy has traditionally been considered the gold-standard procedure, associated complications, the need for general anesthesia, and resource utilization have led to development of other interventions.Interspinous distraction devices (IDDs) are one example.The X-Stop (Medtronic) was approved in 2005 by the US FDA for use in patients with 1-or 2-level LSS and symptoms that improve with flexion.In one study, results with the X-Stop were favorable at the 1-year outcome compared with those of nonsurgical management; 59% of the X-Stop cohort reported significant improvement in the symptom severity and physical function domains of the Zurich Claudication Questionnaire compared with 12% of the nonsurgical cohort, and the authors reported a 1-year reoperation rate of 6% in the X-Stop cohort. 3Other studies have compared X-Stop with lumbar laminectomy and found improvement in outcomes among both cohorts; however, reoperation rates were consistently noted to be significantly higher among the X-Stop cohort. 5,6Since X-Stop can be implanted in an outpatient setting under local anesthesia with shorter procedural times than those required for laminectomy, questions remain regarding whether this device could play a role in the treatment of LSS despite the high reoperation rate.In this issue of Journal of Neurosurgery: Spine, Borg et al. 4 present results of the United Kingdom Cost-Effectiveness and Quality of Life After Laminectomy or X-Stop (CELAX) open-label, randomized controlled trial.Cost was measured per patient episode and included device, operating time, and admission costs.Quality of life (QOL) was measured using the EQ-5D as the primary outcome.Both the laminectomy and X-Stop cohorts reported im-
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