Indications and contraindications: interspinous process decompression devices in lumbar spine surgery

Area of Science:

• Spinal surgery
• Minimally invasive procedures
• Lumbar spinal stenosis treatment

Background:

• Interspinous process decompression devices (IPDs) offer minimally invasive treatment for lumbar spinal stenosis (LSS).
• The clinical utility and indications for IPDs remain controversial despite some supporting evidence.
• This study investigates surgeon perspectives and limitations regarding IPD use in LSS management.

Purpose of the Study:

• To explore surgeon perspectives on the use of interspinous process decompression devices (IPDs) for lumbar spinal stenosis (LSS).
• To identify limitations and contraindications associated with IPD implantation.
• To evaluate the current role and decision-making factors influencing IPD adoption in spinal surgery.

Main Methods:

• A questionnaire was distributed to 1,321 hospitals in Germany with relevant surgical departments.
• The survey included closed-ended and open-ended questions reviewed by spine surgeons and statisticians.
• Analyzable responses were collected from 329 (24.9%) hospitals.

Main Results:

• 49.8% of respondents consider IPDs a treatment option for LSS, with 82.3% of those using them.
• Key reasons for non-use include poor clinical experience (60%) and lack of evidence (53.9%).
• Hospital size and patient volume negatively correlated with IPD use (p=0.001); common use combines IPDs with open decompression (64.4%).

Conclusions:

• No clear consensus exists among spine surgeons regarding IPD use for LSS.
• Hospital characteristics significantly influence the decision to use or not use IPDs.
• Identified indications and contraindications may help improve outcomes and prevent patient harm, despite limited evidence.