IPD for Treatment of Degenerative Lumbar Spine Stenosis
DLSS is a condition that occurs as a result of aging, whereby the narrowing of the central canal and intervertebral foramen is caused by changes in the facet joints, ligamentum flavum, posterior longitudinal ligament, and intervertebral disc.
Neurogenic claudication is commonly linked to narrowing of the central canal, while radicular syndromes usually occur with stenosis of the lateral recess and intervertebral foramen. Additionally, back pain is typically present.
Degenerative listhesis may also be present, with or without instability. These clinical characteristics can be assessed individually or as a whole, resulting in a diverse group of patients with varying presentations.
Although there are no well-defined diagnostic and classification criteria, DLSS with symptoms is a prevalent condition. Radiologic evidence of DLSS has been found in 19% to 47% of cases. DLSS is presently the primary reason for spinal surgery in patients who are over 65 years old.
If non-surgical interventions such as physical therapy, spine injections, and conventional or neuropathic pain medicine do not succeed in relieving pain and improving functionality for the patient, they may consider undergoing surgical treatment as a viable alternative. When radicular pain and/or neurogenic claudication are the main symptoms, decompression appears to be especially advantageous.
The conventional surgical method involves performing a broad decompression, which may be combined with arthrodesis. Several potential adverse outcomes could include postoperative pain, dural tear, blood loss, infection, and immobilization.
According to the literature, the use of an interspinous process device (IPD) may increase the central canal area by as much as 18%.IPDs are presented as a less invasive surgical option, but their safety, effectiveness, and cost-effectiveness are still under investigation. IPDs have been evaluated against conservative treatment or traditional surgery, but there is a general apprehension about potential bias risks and small sample sizes in these studies.
IPD vs Non-Surgical Treatments
When comparing non-surgical treatments (physical therapy, spinal injections, as well as anti-inflammatory and analgesic medications), with IPD implanted using a conventional technique, patients in the IPD group demonstrated a statistically significant greater improvement.
In both scenarios, treatment failure requires laminectomy (or reoperation in the IPD group), but the greater number of patients who require it received non-surgical treatments. Quality of life is improved in patients who submitted to IPD implants, especially in regards to physical activity. However, adverse events are more prevalent in IPD patients.
IPD vs Decompressive Surgery
The IPD group had a higher overall reoperation rate. When considering healthcare costs, social costs, and cost-utility, the likelihood of IPDs being more cost-effective than decompressive surgery was well below 50%.
The cost of IPDs was substantially greater and did not result in an improved quality of life in comparison to surgical decompression. The higher expenses associated with IPDs were due to the cost of the implant and the increased rate of reoperation.
IPD has a noticeably lower rate of treatment failure, and superior pain relief and improved functional outcomes. However, the incidence of complications was observed to be higher in the IPD group when compared to conservative treatment and decompressive surgery. The cost-effectiveness analysis supported the conventional approach.
If you are interested in knowing more about IPD for treatment of degenerative lumbar spine stenosis you have come to the right place!
I am Vedant Vaksha, Fellowship trained Spine, Sports and Arthroscopic Surgeon at Complete Orthopedics. I take care of patients with ailments of the neck, back, shoulder, knee, elbow and ankle. I personally approve this content and have written most of it myself.
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