Explaining Spinal Disorders: Isthmic Spondylolisthesis

The X-Stop® Interspinous Process Decompression system addresses pinched spinal nerves.

Explaining Spinal Disorders: Degenerative Spondylolisthesis

We present a series of six patients who had Grade 1 spondylolisthesis at the time of interspinous device placement and continued to have symptoms of neurogenic intermittent claudication (NIC) after surgery, necessitating device removal and instrumented lumbar fusion.

Degenerative Spondylolisthesis - Spine - …

All six patients reported an improvement in symptoms following device removal and subsequent instrumented fusion. One patient who had not been able to walk due to pain regained the ability to walk. Several articles were identified related to spondylolisthesis and interspinous devices.

Our series included six patients, all women, who were treated at our institution between 2009 and 2013. Mean age at time of interspinous device placement was 63 years (range 51-83 years), and mean time elapsed since interspinous device placement was 35.8 months (range 3-96 months). Mean age at presentation to our clinic was 66 years (range 52-84 years), and mean overall duration of symptoms was 6.3 years (range 2-13 years). Mean follow-up after device removal was 9.2 months (range 4-12 months).


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Teng is the Director of Cascade Spine Center


Cervical / Thoracic / Lumbar Spine Problems
Complex Spine Problems
Degenerative Disc Disease
Disc Herniations
Myelopathy
Radiculopathy
Sciatica
Spinal Infections
Spinal Instability
Spinal Spondylolisthesis
Spinal Spondylolysis
Spinal Spondylosis / Osteoarthritis / Degeneration
Spinal Stenosis
Trauma / Fractures / Neck & Back Injuries
Vertebral Compression/Burst Fractures

Cervical / Thoracic / Lumbar Spine Surgery
Cervical Disc Replacement/Arthroplasty
Decompression
Discectomy, Vertebral Corpectomy
Foraminotomy / Microforaminotomy
Fusion / Spinal Hardware Instrumentation
Integrated Spacers/Cages
Interbody Fusions (ALIF / PLIF / TLIF)
Interspinous Stabilization
Laminectomy / Laminotomy / Laminoplasty
Lateral Access Interbody Fusions
Microscope Assisted Surgery
Minimally Invasive Surgery
Motion Sparing Surgery
Spinal Cord Stimulator - Permanent placement
Transforaminal Epidural Steroid Injection (TFESI/NRB)

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However, patients receiving interspinous spacers are more likely to require repeated back surgery, according to the report by Dr Ricard A. Deyo and colleagues of Oregon Health & Science University, Portland. They conclude, "Use of interspinous spacers poses a trade-off in outcomes: fewer complications for the index operation, but higher rates of subsequent lumbar surgery."

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The studies summarized in were high-quality randomized controlled trials or cohort studies that reviewed the outcomes of patients with and without spondylolisthesis who had the X-STOP implanted, which allowed for a direct comparison of outcomes between these two groups. Seven of these studies, involving five different patient populations, demonstrated no significant difference in clinical outcomes in patients with Grade 1 spondylolisthesis who underwent X-STOP placement.[,,,,,,]

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In conclusion, we report six patients who required interspinous device removal and subsequent surgical decompression, all of whom had Grade 1 spondylolisthesis at the time of device placement. Review of the literature revealed several high-quality studies that found no statistically significant difference in outcomes between patients with or without Grade 1 spondylolisthesis receiving the X-STOP implant. However, surgeons should have a high degree of suspicion of potential complications in patients with Grade 1 spondylolisthesis who received an interspinous device, as many technical aspects may not have been considered before and during placement.