A Review of Emerging Evidence for Utilization of a Percutaneous Interspinous Process Decompression Device to Treat Symptomatic Lumbar Adjacent-Segment Degeneration
Abstract Objective Postlaminectomy syndrome diagnoses secondary to adjacent segment degeneration are a substantial and rising cause of morbidity in the United States. Emerging spinal cord neuromodulation technologies have produced successful outcomes for postlaminectomy neuropathic pain but are less...
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| Veröffentlicht in: | Pain medicine (Malden, Mass.) Mass.), 2019-12, Vol.20 (Supplement_2), p.S9-S13 |
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| creator | Deer, Timothy R Sayed, Dawood Malinowski, Mark N Rowe, Jeffery J Jameson, Jessica B Liang, Kevin Sclafani, Joseph A |
| description | Abstract
Objective
Postlaminectomy syndrome diagnoses secondary to adjacent segment degeneration are a substantial and rising cause of morbidity in the United States. Emerging spinal cord neuromodulation technologies have produced successful outcomes for postlaminectomy neuropathic pain but are less effective in treating neurogenic claudication secondary to recurrent lumbar stenosis. Percutaneous interspinous process decompression systems can be used as a salvage treatment modality for persistent structural neurogenic claudication in postlaminectomy syndrome or after spinal cord stimulator implantation.
Methods
This paper is a review of emerging evidence for efficacious utilization of percutaneous interspinous process decompression.
Results
A recent pragmatic trial of subjects who underwent percutaneous interspinous process decompression for lumbar stenosis with intermittent neurogenic claudication reported that 63% (26/41) maintained minimal clinically important improvement in visual analog scale (VAS) leg pain, 61% (25/41) in VAS back pain, 78% (32/41) in function objective values, and 88% (36/41) reported satisfaction with treatment at 12 months postop. All subjects in a small case series of seven individuals with postlaminectomy adjacent-segment disease reported postoperative satisfaction scores of 3 or 4 on a 0–4 scale and were also able to decrease or wean completely off controlled pain medications. In another study, there was a significant decrease in average leg pain (60% improvement, P |
| doi_str_mv | 10.1093/pm/pnz247 |
| format | Article |
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Objective
Postlaminectomy syndrome diagnoses secondary to adjacent segment degeneration are a substantial and rising cause of morbidity in the United States. Emerging spinal cord neuromodulation technologies have produced successful outcomes for postlaminectomy neuropathic pain but are less effective in treating neurogenic claudication secondary to recurrent lumbar stenosis. Percutaneous interspinous process decompression systems can be used as a salvage treatment modality for persistent structural neurogenic claudication in postlaminectomy syndrome or after spinal cord stimulator implantation.
Methods
This paper is a review of emerging evidence for efficacious utilization of percutaneous interspinous process decompression.
Results
A recent pragmatic trial of subjects who underwent percutaneous interspinous process decompression for lumbar stenosis with intermittent neurogenic claudication reported that 63% (26/41) maintained minimal clinically important improvement in visual analog scale (VAS) leg pain, 61% (25/41) in VAS back pain, 78% (32/41) in function objective values, and 88% (36/41) reported satisfaction with treatment at 12 months postop. All subjects in a small case series of seven individuals with postlaminectomy adjacent-segment disease reported postoperative satisfaction scores of 3 or 4 on a 0–4 scale and were also able to decrease or wean completely off controlled pain medications. In another study, there was a significant decrease in average leg pain (60% improvement, P < 0.0001, N = 25) and axial low back pain (58% improvement, P < 0.0001, N = 25) in patients who underwent one- or two-level percutaneous interspinous process decompression as a rescue treatment for reemerging neurogenic claudication after spinal cord stimulator implantation.
Conclusions
The spine often is a focus of progressive disease. Furthermore, mechanical changes associated with spinal instrumentation can lead to additional disease at adjacent levels. Many individuals will present with symptomatic neurogenic claudication recalcitrant to multimodal management strategies, including even the most sophisticated neuromodulation technologies. Implementation of salvage percutaneous interspinus process decompression implantation in cases of adjacent segment degeneration or incomplete spinal cord stimulation can decompress structural causes of neurogenic claudication while sparing the patient from more invasive surgical reoperation techniques.</description><identifier>ISSN: 1526-2375</identifier><identifier>EISSN: 1526-4637</identifier><identifier>DOI: 10.1093/pm/pnz247</identifier><identifier>PMID: 31808531</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Back pain ; Care and treatment ; Complications ; Complications and side effects ; Decompression ; Decompression, Surgical - methods ; Degeneration ; Degenerative disc disease ; Electrical stimuli ; Evidence-based medicine ; Humans ; Intermittent Claudication - etiology ; Intermittent Claudication - surgery ; Laminectomy ; Low back pain ; Lumbosacral Region - surgery ; Methods ; Morbidity ; Neural stimulation ; Neuralgia ; Neuromodulation ; Pain Management - methods ; Patients ; Postoperative Complications - surgery ; Review ; Spinal cord ; Spinal Stenosis - complications ; Spinal Stenosis - surgery ; Spine (lumbar) ; Stenosis ; Surgery</subject><ispartof>Pain medicine (Malden, Mass.), 2019-12, Vol.20 (Supplement_2), p.S9-S13</ispartof><rights>2019 The Author(s) 2019. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. 2019</rights><rights>2019 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.</rights><rights>COPYRIGHT 2019 Oxford University Press</rights><rights>2019 The Author(s) 2019. Published by Oxford University Press on behalf of the American Academy of Pain Medicine.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c499t-e6ec4df569b4b983a779a798a3e5e6ef905a969be3280d983a1f2a88db3e1e773</citedby><cites>FETCH-LOGICAL-c499t-e6ec4df569b4b983a779a798a3e5e6ef905a969be3280d983a1f2a88db3e1e773</cites><orcidid>0000-0001-6861-0073 ; 0000-0003-0605-0546</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,1584,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31808531$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Deer, Timothy R</creatorcontrib><creatorcontrib>Sayed, Dawood</creatorcontrib><creatorcontrib>Malinowski, Mark N</creatorcontrib><creatorcontrib>Rowe, Jeffery J</creatorcontrib><creatorcontrib>Jameson, Jessica B</creatorcontrib><creatorcontrib>Liang, Kevin</creatorcontrib><creatorcontrib>Sclafani, Joseph A</creatorcontrib><title>A Review of Emerging Evidence for Utilization of a Percutaneous Interspinous Process Decompression Device to Treat Symptomatic Lumbar Adjacent-Segment Degeneration</title><title>Pain medicine (Malden, Mass.)</title><addtitle>Pain Med</addtitle><description>Abstract
Objective
Postlaminectomy syndrome diagnoses secondary to adjacent segment degeneration are a substantial and rising cause of morbidity in the United States. Emerging spinal cord neuromodulation technologies have produced successful outcomes for postlaminectomy neuropathic pain but are less effective in treating neurogenic claudication secondary to recurrent lumbar stenosis. Percutaneous interspinous process decompression systems can be used as a salvage treatment modality for persistent structural neurogenic claudication in postlaminectomy syndrome or after spinal cord stimulator implantation.
Methods
This paper is a review of emerging evidence for efficacious utilization of percutaneous interspinous process decompression.
Results
A recent pragmatic trial of subjects who underwent percutaneous interspinous process decompression for lumbar stenosis with intermittent neurogenic claudication reported that 63% (26/41) maintained minimal clinically important improvement in visual analog scale (VAS) leg pain, 61% (25/41) in VAS back pain, 78% (32/41) in function objective values, and 88% (36/41) reported satisfaction with treatment at 12 months postop. All subjects in a small case series of seven individuals with postlaminectomy adjacent-segment disease reported postoperative satisfaction scores of 3 or 4 on a 0–4 scale and were also able to decrease or wean completely off controlled pain medications. In another study, there was a significant decrease in average leg pain (60% improvement, P < 0.0001, N = 25) and axial low back pain (58% improvement, P < 0.0001, N = 25) in patients who underwent one- or two-level percutaneous interspinous process decompression as a rescue treatment for reemerging neurogenic claudication after spinal cord stimulator implantation.
Conclusions
The spine often is a focus of progressive disease. Furthermore, mechanical changes associated with spinal instrumentation can lead to additional disease at adjacent levels. Many individuals will present with symptomatic neurogenic claudication recalcitrant to multimodal management strategies, including even the most sophisticated neuromodulation technologies. Implementation of salvage percutaneous interspinus process decompression implantation in cases of adjacent segment degeneration or incomplete spinal cord stimulation can decompress structural causes of neurogenic claudication while sparing the patient from more invasive surgical reoperation techniques.</description><subject>Back pain</subject><subject>Care and treatment</subject><subject>Complications</subject><subject>Complications and side effects</subject><subject>Decompression</subject><subject>Decompression, Surgical - methods</subject><subject>Degeneration</subject><subject>Degenerative disc disease</subject><subject>Electrical stimuli</subject><subject>Evidence-based medicine</subject><subject>Humans</subject><subject>Intermittent Claudication - etiology</subject><subject>Intermittent Claudication - surgery</subject><subject>Laminectomy</subject><subject>Low back pain</subject><subject>Lumbosacral Region - surgery</subject><subject>Methods</subject><subject>Morbidity</subject><subject>Neural stimulation</subject><subject>Neuralgia</subject><subject>Neuromodulation</subject><subject>Pain Management - methods</subject><subject>Patients</subject><subject>Postoperative Complications - surgery</subject><subject>Review</subject><subject>Spinal cord</subject><subject>Spinal Stenosis - complications</subject><subject>Spinal Stenosis - surgery</subject><subject>Spine (lumbar)</subject><subject>Stenosis</subject><subject>Surgery</subject><issn>1526-2375</issn><issn>1526-4637</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>TOX</sourceid><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNp9ks1u1DAQxyMEoqVw4AWQJTjAYVt_JGv7grRqF6i0EhVtz5bXmQSvYjvYyaL2dXhRnO5StQghH8b2_OY_nvEUxWuCjwmW7KR3J72_pSV_UhySis5n5Zzxp_s9Zbw6KF6ktMGYzEvBnhcHjAgsKkYOi18L9A22Fn6i0KClg9ha36Ll1tbgDaAmRHQ92M7e6sEGP0EaXUA046A9hDGhcz9ATL310-EiBgMpoTMwwfUxb6egs5wgaw0BXUXQA7q8cf0QXFY0aDW6tY5oUW-0AT_MLqF12eaYFjzEu6wvi2eN7hK82tuj4vrT8ur0y2z19fP56WI1M6WUwwzmYMq6qeZyXa6lYJpzqbkUmkGVfY3ElZbZCYwKXE8AaagWol4zIMA5Oyo-7nT7ce2gnt4Tdaf6aJ2ONypoqx57vP2u2rBVnAgqCckC7_cCMfwYIQ3K2WSg63a9UpRRygnmoszo27_QTRijz-UpWnGRP03QB1SrO1DWNyHnNZOoWnCMy7KUd9TxP6i8anDWBA-NzfePAj7sAkwMKUVo7mskWE0TpXqndhOV2TcPm3JP_hmhDLzbAWHs_6PzG1Re1nI</recordid><startdate>20191201</startdate><enddate>20191201</enddate><creator>Deer, Timothy R</creator><creator>Sayed, Dawood</creator><creator>Malinowski, Mark N</creator><creator>Rowe, Jeffery J</creator><creator>Jameson, Jessica B</creator><creator>Liang, Kevin</creator><creator>Sclafani, Joseph A</creator><general>Oxford University Press</general><scope>TOX</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-6861-0073</orcidid><orcidid>https://orcid.org/0000-0003-0605-0546</orcidid></search><sort><creationdate>20191201</creationdate><title>A Review of Emerging Evidence for Utilization of a Percutaneous Interspinous Process Decompression Device to Treat Symptomatic Lumbar Adjacent-Segment Degeneration</title><author>Deer, Timothy R ; Sayed, Dawood ; Malinowski, Mark N ; Rowe, Jeffery J ; Jameson, Jessica B ; Liang, Kevin ; Sclafani, Joseph A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c499t-e6ec4df569b4b983a779a798a3e5e6ef905a969be3280d983a1f2a88db3e1e773</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Back pain</topic><topic>Care and treatment</topic><topic>Complications</topic><topic>Complications and side effects</topic><topic>Decompression</topic><topic>Decompression, Surgical - methods</topic><topic>Degeneration</topic><topic>Degenerative disc disease</topic><topic>Electrical stimuli</topic><topic>Evidence-based medicine</topic><topic>Humans</topic><topic>Intermittent Claudication - etiology</topic><topic>Intermittent Claudication - surgery</topic><topic>Laminectomy</topic><topic>Low back pain</topic><topic>Lumbosacral Region - surgery</topic><topic>Methods</topic><topic>Morbidity</topic><topic>Neural stimulation</topic><topic>Neuralgia</topic><topic>Neuromodulation</topic><topic>Pain Management - methods</topic><topic>Patients</topic><topic>Postoperative Complications - surgery</topic><topic>Review</topic><topic>Spinal cord</topic><topic>Spinal Stenosis - complications</topic><topic>Spinal Stenosis - surgery</topic><topic>Spine (lumbar)</topic><topic>Stenosis</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Deer, Timothy R</creatorcontrib><creatorcontrib>Sayed, Dawood</creatorcontrib><creatorcontrib>Malinowski, Mark N</creatorcontrib><creatorcontrib>Rowe, Jeffery J</creatorcontrib><creatorcontrib>Jameson, Jessica B</creatorcontrib><creatorcontrib>Liang, Kevin</creatorcontrib><creatorcontrib>Sclafani, Joseph A</creatorcontrib><collection>Oxford Journals Open Access Collection</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Psychology Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Pain medicine (Malden, Mass.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Deer, Timothy R</au><au>Sayed, Dawood</au><au>Malinowski, Mark N</au><au>Rowe, Jeffery J</au><au>Jameson, Jessica B</au><au>Liang, Kevin</au><au>Sclafani, Joseph A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A Review of Emerging Evidence for Utilization of a Percutaneous Interspinous Process Decompression Device to Treat Symptomatic Lumbar Adjacent-Segment Degeneration</atitle><jtitle>Pain medicine (Malden, Mass.)</jtitle><addtitle>Pain Med</addtitle><date>2019-12-01</date><risdate>2019</risdate><volume>20</volume><issue>Supplement_2</issue><spage>S9</spage><epage>S13</epage><pages>S9-S13</pages><issn>1526-2375</issn><eissn>1526-4637</eissn><abstract>Abstract
Objective
Postlaminectomy syndrome diagnoses secondary to adjacent segment degeneration are a substantial and rising cause of morbidity in the United States. Emerging spinal cord neuromodulation technologies have produced successful outcomes for postlaminectomy neuropathic pain but are less effective in treating neurogenic claudication secondary to recurrent lumbar stenosis. Percutaneous interspinous process decompression systems can be used as a salvage treatment modality for persistent structural neurogenic claudication in postlaminectomy syndrome or after spinal cord stimulator implantation.
Methods
This paper is a review of emerging evidence for efficacious utilization of percutaneous interspinous process decompression.
Results
A recent pragmatic trial of subjects who underwent percutaneous interspinous process decompression for lumbar stenosis with intermittent neurogenic claudication reported that 63% (26/41) maintained minimal clinically important improvement in visual analog scale (VAS) leg pain, 61% (25/41) in VAS back pain, 78% (32/41) in function objective values, and 88% (36/41) reported satisfaction with treatment at 12 months postop. All subjects in a small case series of seven individuals with postlaminectomy adjacent-segment disease reported postoperative satisfaction scores of 3 or 4 on a 0–4 scale and were also able to decrease or wean completely off controlled pain medications. In another study, there was a significant decrease in average leg pain (60% improvement, P < 0.0001, N = 25) and axial low back pain (58% improvement, P < 0.0001, N = 25) in patients who underwent one- or two-level percutaneous interspinous process decompression as a rescue treatment for reemerging neurogenic claudication after spinal cord stimulator implantation.
Conclusions
The spine often is a focus of progressive disease. Furthermore, mechanical changes associated with spinal instrumentation can lead to additional disease at adjacent levels. Many individuals will present with symptomatic neurogenic claudication recalcitrant to multimodal management strategies, including even the most sophisticated neuromodulation technologies. Implementation of salvage percutaneous interspinus process decompression implantation in cases of adjacent segment degeneration or incomplete spinal cord stimulation can decompress structural causes of neurogenic claudication while sparing the patient from more invasive surgical reoperation techniques.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>31808531</pmid><doi>10.1093/pm/pnz247</doi><orcidid>https://orcid.org/0000-0001-6861-0073</orcidid><orcidid>https://orcid.org/0000-0003-0605-0546</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Pain medicine (Malden, Mass.), 2019-12, Vol.20 (Supplement_2), p.S9-S13 |
| issn | 1526-2375 1526-4637 |
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| source | MEDLINE; Oxford University Press Journals All Titles (1996-Current); Alma/SFX Local Collection |
| subjects | Back pain Care and treatment Complications Complications and side effects Decompression Decompression, Surgical - methods Degeneration Degenerative disc disease Electrical stimuli Evidence-based medicine Humans Intermittent Claudication - etiology Intermittent Claudication - surgery Laminectomy Low back pain Lumbosacral Region - surgery Methods Morbidity Neural stimulation Neuralgia Neuromodulation Pain Management - methods Patients Postoperative Complications - surgery Review Spinal cord Spinal Stenosis - complications Spinal Stenosis - surgery Spine (lumbar) Stenosis Surgery |
| title | A Review of Emerging Evidence for Utilization of a Percutaneous Interspinous Process Decompression Device to Treat Symptomatic Lumbar Adjacent-Segment Degeneration |
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