Adoption and Decline of Interspinous Process Devices for Lumbar Spinal Stenosis From 2017 Through 2022

Area of Science:

• Spinal surgery
• Orthopedic surgery
• Neurosurgery

Background:

• Interspinous process devices (IPDs) offer a less invasive surgical option for lumbar spinal stenosis (LSS).
• The clinical effectiveness and utilization trends of IPDs have been subject to ongoing debate.
• Limited large-scale studies have investigated recent IPD usage patterns and revision surgery rates.

Purpose of the Study:

• To analyze trends in the utilization of interspinous process devices (IPDs) for lumbar spinal stenosis (LSS) between 2017 and 2022.
• To examine changes in provider specialties and surgical techniques associated with IPD placement.
• To evaluate the 3-year revision surgery rates following IPD implantation.

Main Methods:

• Utilized the M170Ortho PearlDiver Database (2017-2022) to identify 10,422 patients undergoing IPD placement for LSS.
• Stratified patients based on direct lumbar decompression and the number of spinal levels treated.
• Assessed yearly IPD utilization, provider specialties, and performed Kaplan-Meier survival analyses for 3-year reoperation rates.

Main Results:

• IPD utilization increased from 2017 to 2020, followed by a significant decrease from 2020 to 2022.
• The proportion of IPDs placed without direct decompression increased over time (59.3%).
• Pain specialists became the predominant providers of IPDs, while orthopaedic/neurologic surgeon utilization declined. The overall 3-year revision surgery rate was 12.0% without significant differences based on decompression or levels treated.

Conclusions:

• This study reveals a notable shift in IPD utilization trends, with a decline observed after 2020.
• The increasing use of IPDs without decompression and by pain specialists correlates with this utilization decrease.
• Despite changing practice patterns, revision surgery rates remained consistent, suggesting evolving physician practices rather than device efficacy changes.