Interspinous spacers versus PLIF in treatment of degenerative lumbar spinal diseases

Study Type: Meta analysis
OE Level of Evidence: 2
Journal Level of Evidence: N/A
10 studies including 5 randomized controlled trials (RCTs) and 5 prospective trials were included in this meta-analysis to compare the safety and effectiveness of interspinous spacers and posterior lumbar interbody fusion (PLIF) in the treatment of patients with degenerative lumbar spinal diseases. Findings indicated no significant differences between treatment groups for pooled complication rates, postoperative pain, postoperative disability, duration of hospital stay, and postoperative range of motion in the distal segment. A significantly lower Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Not Reported
Conflicts: None disclosed
Why was this study needed now?
Conservative methods are the first line of treatment for degenerative lumbar spinal diseases, although patients unresponsive to this type of treatment must undergo operative procedures. Posterior lumbar interbody fusion (PLIF) is one of the traditional surgical methods for such spinal diseases, but limitations to this procedure are still present. Therefore, a new treatment modality including the use of interspinous spacers to reduce intradiscal pressure by widening the interspinous space has been suggested as an alternative to PLIF. Due to the relative novelty of interspinous spacers for degenerative lumbar spinal diseases, pooling of the available evidence and analysis of its safety and effectiveness was warranted.
What was the principal research question?
In the treatment of degenerative lumbar disc disease, how do interspinous spacers compare to conventional posterior lumbar interbody fusion in terms of efficacy and safety outcomes?
Data Source: PubMed, Web of Science, and Cochrane Library databases were searched for relevant studies in September 2015.
Index Terms: Search terms included combinations of the following: "posterior lumbar interbody fusion", "interspinous dynamic system", "DIAM", "Coflex", "X-Stop", "Wallis", "interspinous implantation", "interspinous spacer", "interspinous process device", "lumbar spinal stenosis", "herniation of intervertebral disc", and "degenerative".
Study Selection: Eligibility criteria for inclusion consisted of studies with comparisons between interspinous spacers and PLIF. 10 studies consisting of 5 RCTs and 5 prospective trials, and a total of 961 patients were included.
Data Extraction: Two reviewers independently extracted data from the included studies. Disagreements were resolved by the senior authors of the study. Primary outcomes included complication rate and postoperative pain (measured using a visual analogue scale; VAS) and disability (measured using the Oswestry Disability Index; ODI). Secondary outcomes consisted of estimated blood loss, operative time, the length of hospital stay, and range of motion (ROM) at the surgical, proximal, and distal segments.
Data Synthesis: Data was pooled using Review Manager 5.2 (RevMan 5.2, Cochrane Collaboration, Oxford, UK). Continuous outcomes were calculated using weighted mean differences (WMD) with 95% confidence intervals (CIs) and dichotomous outcomes were reported using odds ratios (OR) and 95% CI. Heterogeneity was evaluated using the Chi-square test and assessed using the I^2 statistic.
What were the important findings?
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.