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      KCI등재 SCOPUS

      Role of Coflex as an Adjunct to Decompression for Symptomatic Lumbar Spinal Stenosis

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      https://www.riss.kr/link?id=A105943750

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      다국어 초록 (Multilingual Abstract)

      Study design: Prospective cohort study. Purpose: To assess whether additional implantation of Coflex following spinal decompression provided better clinical outcomes compared to decompression alone for symptomatic lumbar spinal stenosis (LSS) and to d...

      Study design: Prospective cohort study.
      Purpose: To assess whether additional implantation of Coflex following spinal decompression provided better clinical outcomes compared to decompression alone for symptomatic lumbar spinal stenosis (LSS) and to determine whether improvement in clinical outcomes correlated with changes in the radiological indices studied.
      Overview of Literature: Literature on benefits of additional Coflex implantation compared to decompression alone for symptomatic LSS is limited.
      Methods: Patients with symptomatic LSS who met the study criteria were offered spinal decompression with Coflex implantation.
      Those patients who accepted Coflex implantation were placed in the Coflex group (n=22); while those opting for decompression alone, were placed in the comparison group (n=24). Clinical outcomes were assessed preoperatively, six-months, one-year and two-years postoperatively, using the Oswestry disability index, 100 mm visual analogue scale (VAS)-back pain and VAS-leg pain, and short form- 36 (SF-36). Radiological indices (disc height, foraminal height and sagittal angle) were assessed preoperatively, six months, one year, and two years postoperatively.
      Results: Both groups showed statistically significant (p <0.001) improvement in all the clinical outcome indicators at all points in time as compared to the preoperative status. However, improvement in the Coflex group was significantly greater (p <0.001) than the comparison group. Changes in the radiological indices did not correlate significantly with the improvement in clinical outcome indicators.
      Conclusions: Additional Coflex implantation after spinal decompression in symptomatic LSS offers better clinical outcomes than decompression alone in the short-term. Changes in radiological indices do not correlate with the improvements in clinical outcomes after surgery for symptomatic LSS.

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      참고문헌 (Reference)

      1 Mariconda M, "Unilateral laminectomy for bilateral decompression of lumbar spinal stenosis: a prospective comparative study with conservatively treated patients" 15 : 39-46, 2002

      2 Richards JC, "The treatment mechanism of an interspinous process implant for lumbar neurogenic intermittent claudication" 30 : 744-749, 2005

      3 Cabraja M, "The short- and mid-term effect of dynamic interspinous distraction in the treatment of recurrent lumbar facet joint pain" 18 : 1686-1694, 2009

      4 Ogikubo O, "The relationship between the cross-sectional area of the cauda equina and the preoperative symptoms in central lumbar spinal stenosis" 32 : 1423-1428, 2007

      5 Anjarwalla NK, "The outcome of spinal decompression surgery 5 years on" 16 : 1842-1847, 2007

      6 Lindsey DP, "The effects of an interspinous implant on the kinematics of the instrumented and adjacent levels in the lumbar spine" 28 : 2192-2197, 2003

      7 Kim MC, "The clinical and radiological outcomes of minimally invasive transforaminal lumbar interbody single level fusion" 5 : 111-116, 2011

      8 Weinstein JN, "Surgical versus nonsurgical therapy for lumbar spinal stenosis" 358 : 794-810, 2008

      9 Celik H, "Surgical treatment of the spinal stenosis with an interspinous distraction device: do we really restore the foraminal height?" 22 : 50-54, 2012

      10 Malmivaara A, "Surgical or nonoperative treatment for lumbar spinal stenosis? A randomized controlled trial" 32 : 1-8, 2007

      1 Mariconda M, "Unilateral laminectomy for bilateral decompression of lumbar spinal stenosis: a prospective comparative study with conservatively treated patients" 15 : 39-46, 2002

      2 Richards JC, "The treatment mechanism of an interspinous process implant for lumbar neurogenic intermittent claudication" 30 : 744-749, 2005

      3 Cabraja M, "The short- and mid-term effect of dynamic interspinous distraction in the treatment of recurrent lumbar facet joint pain" 18 : 1686-1694, 2009

      4 Ogikubo O, "The relationship between the cross-sectional area of the cauda equina and the preoperative symptoms in central lumbar spinal stenosis" 32 : 1423-1428, 2007

      5 Anjarwalla NK, "The outcome of spinal decompression surgery 5 years on" 16 : 1842-1847, 2007

      6 Lindsey DP, "The effects of an interspinous implant on the kinematics of the instrumented and adjacent levels in the lumbar spine" 28 : 2192-2197, 2003

      7 Kim MC, "The clinical and radiological outcomes of minimally invasive transforaminal lumbar interbody single level fusion" 5 : 111-116, 2011

      8 Weinstein JN, "Surgical versus nonsurgical therapy for lumbar spinal stenosis" 358 : 794-810, 2008

      9 Celik H, "Surgical treatment of the spinal stenosis with an interspinous distraction device: do we really restore the foraminal height?" 22 : 50-54, 2012

      10 Malmivaara A, "Surgical or nonoperative treatment for lumbar spinal stenosis? A randomized controlled trial" 32 : 1-8, 2007

      11 Sigmundsson FG, "Prognostic factors in lumbar spinal stenosis surgery" 83 : 536-542, 2012

      12 Penning L, "Posture-dependent bilateral compression of L4 or L5 nerve roots in facet hypertrophy. A dynamic CT-myelographic study" 12 : 488-500, 1987

      13 Seong YJ, "Posterior decompression and fusion in patients with multilevel lumbar foraminal stenosis: a comparison of segmental decompression and wide decompression" 5 : 100-106, 2011

      14 Fraser JF, "Pathogenesis, presentation, and treatment of lumbar spinal stenosis associated with coronal or sagittal spinal deformities" 14 : e6-, 2003

      15 Doo Sik Kong, "One-year Outcome Evaluation after Interspinous Implantation for Degenerative Spinal Stenosis with Segmental Instability" 대한의학회 22 (22): 330-335, 2007

      16 Ahmed M, "Neck and low back pain: neuroimaging" 25 : 439-471, 2007

      17 Fujiwara A, "Morphologic changes in the lumbar intervertebral foramen due to flexion-extension, lateral bending, and axial rotation: an in vitro anatomic and biomechanical study" 26 : 876-882, 2001

      18 박성철, "Minimum 2-Year Follow-Up Result of Degenerative Spinal Stenosis Treated with Interspinous U (CoflexTM)" 대한신경외과학회 46 (46): 292-299, 2009

      19 Athiviraham A, "Is spinal stenosis better treated surgically or nonsurgically?" 458 : 90-93, 2007

      20 Bono CM, "Interspinous process devices in the lumbar spine" 20 : 255-261, 2007

      21 Yone K, "Indication of fusion for lumbar spinal stenosis in elderly patients and its significance" 21 : 242-248, 1996

      22 Chung SS, "Effect of low back posture on the morphology of the spinal canal" 29 : 217-223, 2000

      23 Willen J, "Dynamic effects on the lumbar spinal canal: axially loaded CT-myelography and MRI in patients with sciatica and/or neurogenic claudication" 22 : 2968-2976, 1997

      24 Richter A, "Does an interspinous device (Coflex) improve the outcome of decompressive surgery in lumbar spinal stenosis? One-year follow up of a prospective case control study of 60 patients" 19 : 283-289, 2010

      25 Lin SI, "Disability in patients with degenerative lumbar spinal stenosis" 87 : 1250-1256, 2006

      26 Sengupta DK, "Degenerative spondylolisthesis: review of current trends and controversies" 30 (30): S71-S81, 2005

      27 Spivak JM, "Degenerative lumbar spinal stenosis" 80 : 1053-1066, 1998

      28 Kettler A, "Can a modified interspinous spacer prevent instability in axial rotation and lateral bending? A biomechanical in vitro study resulting in a new idea" 23 : 242-247, 2008

      29 Wilke HJ, "Biomechanical effect of different lumbar interspinous implants on flexibility and intradiscal pressure" 17 : 1049-1056, 2008

      30 Verbiest H, "A radicular syndrome from developmental narrowing of the lumbar vertebral canal" 36 : 230-237, 1954

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