Percutaneous Interspinous Spacer vs Decompression in Patients with Neurogenic Claudication: An Alternative in...

Area of Science:

• Spine surgery
• Minimally invasive procedures
• Degenerative lumbar spinal stenosis

Background:

• Interspinous process devices (IPDs) for lumbar spinal stenosis (LSS) have yielded inconsistent outcomes.
• Neurogenic intermittent claudication (NIC) is a common symptom of LSS impacting quality of life.

Purpose of the Study:

• To evaluate the safety and noninferiority of minimally invasive percutaneous IPDs compared to standalone decompressive surgery (SDS) for LSS with NIC.

Main Methods:

• A multicenter, international, randomized controlled trial (RCT) included 163 patients with LSS and NIC.
• Patients were randomized 1:1 to receive either IPD or SDS, with follow-up at 24 months.

Main Results:

• Both IPD and SDS groups showed significant improvements in physical function, leg pain, and overall satisfaction.
• IPDs were associated with shorter surgical times and less blood loss but had a higher reoperation rate (18.2% vs. 9.3%).
• IPDs achieved noninferiority to SDS for symptom relief at 24 months, but not at 12 months.

Conclusions:

• Interspinous process devices (IPDs) and standalone decompressive surgery (SDS) provide comparable symptom relief for selected LSS patients.
• While IPDs offer advantages in surgical outcomes, a higher reoperation rate necessitates careful patient selection and further investigation.