Die perkutane Implantation eines interspinösen Spacers an der Lendenwirbelsäule
Perkutane Implantation eines interspinösen Spacers an
der Lendenwirbelsäule (LWS) zur Erweiterung des Spinalkanals
sowie zur Entlastung der Wirbelgelenke und der
Bandscheibe bei dynamischen lumbalen Spinalstenosen
sowie gelenk- und/oder bandscheibenbedingten Rückenschmerzen
durch segmentale Distraktion des betroffenen
lumbalen Bewegungssegmentes. Das Verfahren dient als
temporäre Alternative zu invasiveren OP-Verfahren.
Zentrale, laterale und foraminale dynamische lumbale
Symptomatische segmentale Hyperlordose.
Bandscheibendegeneration mit dynamischer Retrolisthese
und Spontanreposition in Flexion.
Interspinöser Schmerz, sog. Baastrup-Phänomen oder
Degenerative und/oder idiopathische Spondylolisthese.
Dorsale Voroperation im gleichen Segment.
Perkutane, minimal invasive Implantation eines interspinösen
Spacers (InSpaceTM, Synthes, Oberdorf, Switzerland)
zur segmentalen Distraktion.
Funktionell ohne Restriktionen.
Gute klinische Ergebnisse bei 42 Patienten nach 2 Jahren.
Bei 76% subjektive Patientenzufriedenheit. Keine zugangsbedingten
Komplikationen. Vermeidung des invasiveren
Alternativeingriffes bei 76,2% der Patienten.
Surgical treatment of dynamic lumbar spinal stenosis and
discogenic/arthrogenic low back pain with a new percutaneous
interspinous spacer as a therapeutic alternative to
more invasive standard procedures.
Central, lateral and foraminal dynamic lumbar spinal
Discogenic and arthrogenic (facet osteoarthritis) low back
Symptomatic, segmental hyperlordosis.
Disc degeneration with dynamic (reducible) retrolisthesis.
Interspinous pain (‚Kissing-Spines’).
Structural spinal stenosis.
Spondylolisthesis (degenerative and/or isthmic).
Previous posterior operation in index segment.
Percutanous, minimally invasive implantation of an interspinous
spacer (InSpaceTM, Synthes, Oberdorf, Switzerland).
Early unrestricted mobilization.
Good early results (after 2 year follow-up) in 42 patients
with 76% subjective patient satisfaction rate. No approach
related complications. Avoidance of the more invasive alternative
procedure (decompression, fusion, total disc replacement)
in 76.2% of the patients.
Spinalstenose-Interspinöse Spacer-Rückenschmerz-Perkutaner Zugang
Spinal stenosis-Interspinous spacer-Low back
- SourceAvailable from: Douglas Wardlaw[show abstract] [hide abstract]
ABSTRACT: Measurements of cross sections of exit foramen and spinal canal were performed before and after placement of X Stop in physiologic postures using positional MR scanner at the stenosed level in patients with lumbar spinal stenosis. To quantify the effect of the implant in vivo on the lumbar spine at the instrumented levels in various postures. Dimensions of the spinal canal and neural foramen decrease from flexion to extension. Symptoms of spinal stenosis occur typically in standing or extension. The X Stop device is designed to distract the posterior elements of the stenotic segment and place it in flexion to treat neurogenic claudication. We think that the device will improve the dimension of the canal in standing and extension. Twenty-six patients with lumbar spine stenosis underwent a one- or two-level X Stop procedure. All had preoperative and postoperative positional MRI in standing, supine, and sitting flexion and extension. Measurements were carried out on the images acquired. Significant increase in the dimensions of the neural foramen and canal area were demonstrated after surgery. The X Stop device improves the degree of central and foraminal stenosis in vivo.Spine 01/2007; 31(25):2958-62. · 2.16 Impact Factor
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ABSTRACT: Measurement of the kinematics of the lumbar spine after insertion of an interspinous spacer in vitro. To understand the kinematics of the instrumented and adjacent levels due to the insertion of this interspinous implant. An interspinous spacer (X Stop, SFMT, Concord, California) has been developed to treat neurogenic intermittent claudication by placing the stenotic segment in slight flexion and preventing extension. This restriction of motion by the interspinous implant may affect the kinematics of levels adjacent to the instrumented level. Seven lumbar spines (L2-L5) were tested in flexion-extension, lateral bending, and axial rotation. Images were taken during each test to determine the kinematics of each motion segment. The interspinous implant was placed at the L3-L4 level, and the test protocol was repeated. The flexion-extension range of motion was significantly reduced at the instrumented level. Axial rotation and lateral bending ranges of motion were not affected at the instrumented level. The range of motion in flexion-extension, axial rotation, and lateral bending at the adjacent segments was not significantly affected by the implant. The implant does not significantly alter the kinematics of the motion segments adjacent to the instrumented level.Spine 11/2003; 28(19):2192-7. · 2.16 Impact Factor
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ABSTRACT: Biomechanical. To determine if cement injection into the spinous process will improve compression strength. The X STOP (St. Francis Medical Technologies) has been shown to be a safe and effective means for decompressing 1- or 2-level lumbar spinal stenosis (LSS). The X STOP is indicated for LSS patients with osteoporosis, but contraindicated for patients with severe osteoporosis. In an attempt to address these LSS patients with demonstrably weaker bone, a technique to strengthen the spinous process with polymethylmethacrylate (PMMA) injection is presented. Nine pairs of adjacent fresh frozen cadaveric lumbar vertebrae were DEXA scanned before testing. They were randomly assigned to the PMMA group and a control group. Nine of the specimens were injected with PMMA. Each spinous process was then compressed between 2 X STOPs. The testing model was designed to simulate the loading of a 2-level X STOP placement. The mean load to failure and stiffness values of the treated and untreated groups were calculated. The specimens were inspected carefully for PMMA infiltration and extrusion. The mean bone mineral density (BMD) values of the control and PMMA treatment groups were 0.99 +/- 0.13 g/cm and 0.98 +/- 0.10 g/cm, respectively; P > 0.616. The mean volume of cement injected was 2.2 +/- 0.3 cc. The mean failure load values of the control and PMMA treatment groups were 1250 +/- 627 N and 2386 +/- 1034 N, respectively; P < 0.001. The mean stiffness values of the control and PMMA treatment groups were 296 +/- 139 N/mm and 381 +/- 131 N/mm, respectively; P > 0.059. Most specimens had flow of the cement into the laminae and some into the facet and pedicle. No PMMA was found within the spinal canal. This first reported technique of posterior element vertebroplasty may increase the indications and success for patients with decreased BMD who seek an interspinous implant such as the X STOP. A possible role may exist in increasing the effectiveness of such devices. However, clinical trials have yet been performed. These results demonstrate that PMMA injection in the spinous processes is effective in increasing resistance to compressive forces in an X STOP model.Spine 02/2008; 33(4):452-6. · 2.16 Impact Factor