Two interspinous spacers in the treatment of bisegmental degenerative disc disease

Author(s): DANIEL ZARZYCKI, ANDRZEJ SMĘTKOWSKI, JOANNA LASOTA, PAWEŁ RADŁO, KRZYSZTOF ŁOKAS

Introduction. Conventional surgical treatment of degenerative disc disease include decompression of neural structures and spinal fusion. Unfortunately fusion leads to overload the adjacent segment what triggers off new symptoms on new level. These cases led to develop a dynamic stabilization technology. Interspinous spacers are one the type of dynamic stabilization. Material and methods. The study included 28 patients operated with two interspinous spacers. Mean age at the day of surgery was 44 years. Two-level degenerative disc disease was confirmed on MRI and neurological examination determined symptomatic spinal level. Second intespinous spacer was implanted to protect asymptomatic adjacent segment which was degenerative on MRI. Saggital scans of T2 sequence of MRI performed before and 6 months after the surgery were compared. Intervertebral foramen height and disc bulge were assessed. Intervertebral angle of operated segments and posterior disc height were also compared on lateral X-Ray of lumbar spine. Clinical outcomes were assessed on the basis of own scale which included Visual Analog Scale of pain, subjective improvement and physical activity. Outcomes. Disc bulge decreased average 22% in 6 months after surgery. Height of intervertebral foramen increased mean 17,4% for upper segment and 18,9% for lower segment. Intervertebral angel of upper level decreased mean 56% and lower level decreased 37%. Posterior disc height increased average 45% for superior segment and 60% for inferior segment. Clinically very good result obtained 28,6% patients, good 35,7% patients, satisfactory 21,4% a bad 14,2% patients. Conclusions. 1. Implantation of two interspinous spacers in patients with degenerative disc disease decrease pain and limitation In physical activity in 76% patients. 2. Procedure of implantation is quick, safe and gives low percentage of complications.