TY - JOUR
T1 - Effectiveness of Interspinous Process Devices in Managing Adjacent Segment Degeneration Following Lumbar Spinal Fusion
T2 - A Systematic Review and Meta-Analysis
AU - Mangal, Harris
AU - Felzensztein Recher, David
AU - Shafafy, Roozbeh
AU - Itshayek, Eyal
N1 - Publisher Copyright:
© 2024 by the authors.
PY - 2024/9
Y1 - 2024/9
N2 - Background: Adjacent segment degeneration (ASD) is a significant complication following lumbar spinal fusion, often necessitating further surgical interventions and impairing patient outcomes. Interspinous process devices were introduced as an alternative treatment for spinal stenosis and degenerative spondylolisthesis and can potentially reduce the incidence of ASDd. This systematic review and meta-analysis aims to evaluate the effectiveness of interspinous process devices or IPDs in managing ASD following a previous spinal fusion compared to traditional fusion techniques. Methods: Electronic databases, including PubMed, Embase, and the Cochrane Library, were queried for studies assessing IPDs against traditional lumbar fusion methods for managing ASD after previous lumbar fusion, which had been published between January 2014 and the present. Statistical analysis was conducted using Review Manager 5.4. Results: Seven retrospective cohort studies involving 546 patients met the inclusion criteria. The analysis revealed that IPDs were associated with a statistically significant reduction in the incidence of ASD (OR = 0.28, 95% CI: 0.16 to 0.51, p < 0.0001, and I2 = 0% after excluding outliers). The ODI demonstrated a non-significant trend towards improved outcomes with IPDs at the 2-year follow-up (SMD = −3.94; 95% CI: −11.72 to 3.85). Range of motion (ROM) was better preserved with IPDs compared to fusion (SMD = 0.00, 95% CI: −0.41 to 0.41, p = 1.00, I2 = 60%). The visual analogue scale or VAS lower back pain scores were significantly reduced at the 2-year follow-up (SMD = −0.69, 95% CI: −1.18 to −0.19, p = 0.006, and I2 = 74%). VAS leg pain showed consistent improvements (SMD = −0.29; 95% CI: −0.63 to 0.04). Intraoperative blood loss was significantly lower with IPDs (SMD = −2.07; 95% CI: −3.27 to −0.87, p = 0.0007, and I2 = 95%), and operation times were shorter (SMD = −2.22, 95% CI: −3.31 to −1.12, p < 0.0001, and I2 = 94%). Conclusions: The judicious use of IPDs might benefit a subset of patients, particularly those who are not suitable candidates for major corrective surgery.
AB - Background: Adjacent segment degeneration (ASD) is a significant complication following lumbar spinal fusion, often necessitating further surgical interventions and impairing patient outcomes. Interspinous process devices were introduced as an alternative treatment for spinal stenosis and degenerative spondylolisthesis and can potentially reduce the incidence of ASDd. This systematic review and meta-analysis aims to evaluate the effectiveness of interspinous process devices or IPDs in managing ASD following a previous spinal fusion compared to traditional fusion techniques. Methods: Electronic databases, including PubMed, Embase, and the Cochrane Library, were queried for studies assessing IPDs against traditional lumbar fusion methods for managing ASD after previous lumbar fusion, which had been published between January 2014 and the present. Statistical analysis was conducted using Review Manager 5.4. Results: Seven retrospective cohort studies involving 546 patients met the inclusion criteria. The analysis revealed that IPDs were associated with a statistically significant reduction in the incidence of ASD (OR = 0.28, 95% CI: 0.16 to 0.51, p < 0.0001, and I2 = 0% after excluding outliers). The ODI demonstrated a non-significant trend towards improved outcomes with IPDs at the 2-year follow-up (SMD = −3.94; 95% CI: −11.72 to 3.85). Range of motion (ROM) was better preserved with IPDs compared to fusion (SMD = 0.00, 95% CI: −0.41 to 0.41, p = 1.00, I2 = 60%). The visual analogue scale or VAS lower back pain scores were significantly reduced at the 2-year follow-up (SMD = −0.69, 95% CI: −1.18 to −0.19, p = 0.006, and I2 = 74%). VAS leg pain showed consistent improvements (SMD = −0.29; 95% CI: −0.63 to 0.04). Intraoperative blood loss was significantly lower with IPDs (SMD = −2.07; 95% CI: −3.27 to −0.87, p = 0.0007, and I2 = 95%), and operation times were shorter (SMD = −2.22, 95% CI: −3.31 to −1.12, p < 0.0001, and I2 = 94%). Conclusions: The judicious use of IPDs might benefit a subset of patients, particularly those who are not suitable candidates for major corrective surgery.
KW - adjacent segment disease
KW - interspinous device
KW - lumbar spinal fusion
KW - meta-analysis
KW - systematic review
UR - http://www.scopus.com/inward/record.url?scp=85203662946&partnerID=8YFLogxK
U2 - 10.3390/jcm13175160
DO - 10.3390/jcm13175160
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C2 - 39274374
AN - SCOPUS:85203662946
SN - 2077-0383
VL - 13
JO - Journal of Clinical Medicine
JF - Journal of Clinical Medicine
IS - 17
M1 - 5160
ER -