The Clinical Significance Of Interspinous Process Devices And Imaging Changes After Implantation

Objective:1.To explore the midterm clinical effect of interspinous process device in thetreatment of degenerative disc disease.2. To analysis the lumbar changes after the implantation ofX-Stop and Wallis system,based on the measurement of the Cobb angle, the height ofintervertebral space,intervertebral foramen diameter pre-and post-opration.Methods:1.A total of91patients after interspinous process device(X-Stop) surgery withdegenerative disc disease between November2009and July2012,including32male and59female.the mean age was （56.6±10.3） years.The visual analog score(VAS) and JapaneseOrthopedic Association score (JOA) are used to evaluate the improvement of clinicalsymptoms.2.61patients with L4/5segment lumbar degenerative disc disease were divided intoX-Stop group (A group,33patients including11male and22female,the mean age was54.5±11.8years) and Wallis group (B group,28patients including14male and14female,the mean age was48.8±13.8years).Both groups took Standard radiographs before and after surgery,and measuredby there Non operation people. The X-ray measurement included:(1) Cobb angle:the vertical angleof adjacent vertebral superior endplates.(2)the intervertebral foramen diameter and longitudinaldiameter/L5vertebral height,(3)disc height/L5vertebral height.Results:1.There were5patients with only X-Stop system implated,and withoutdecompresion or discectomy;4patients used X-Stop system combined with Pedicle screwsystem;the rest of patients implanted X-Stop system with decompresion or discectomy.Thepostoperative follow-up averaged34.3months(ranged:20-52months)for all cases.3patients hasresidual low back pain and lower limb numbness,remitting after conservative treatment.1patientfound clicking when the lumbar Flexion and extension without pain or nerve irritation.1patientunderwent secondary operation because of recurrent lumbar disc herniation after1year.TheX-Stop system drop out behind the spinous process in2patient,with no symptoms.Nocomplications in the follow-up proess such as spinous process fracture,lumbar kyphosis. VASwere decreased from5.74±0.99to0.65±0.87(P＜0.05), and JOA scores were increased from13.46±2.75to27.46±1.40(P＜0.05),the improvement rate of JOA score was90.1%.2.Themeasurement index was significantly increased in the two groups (P<0.05).The change of Cobbangle and the intervertebral foramen diameter and longitudinal diameter/L5vertebral heightshowed no significant diferent between two groups(P>0.05), disc height/L5vertebral heightchanges was diferent between two groups(P<0.05).Conclusion:The Interspinous Process Devices （X-Stop） can restore lumbar lordosis, effectively increase the foraminal area and intervertebral height,relax the nerve root and restorenormal physiological structure of lumbar.It is a safe and effective surgical method in the treatmentof lumbar degenerative disc disease,because of its good clinical efficacy,early recovery,fewertrauma and fewer complication.