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2013년 11월 19일 화요일

Percutaneous interspinous spacer versus open decompression: a 2-year follow-up of clinical outcome and quality of life.

Brief review

이 논문은 척추의 극돌기 사이에 spacer라고 하는 확장기를 삽입하는 수술과 기존의 개복을 통한 감압수술(요추3-4번 혹은 요추 4-5)을 받은 45명의 환자를 대상으로 각각 2년간의 추적조사를 통해 임상적 결과와 삶의 질을 비교하는 내용 입니다
수술 후의 삶의 질, 일상생활 가능 정도, 보행거리 등을 평가하였으며 2년간 대상 환자들을 추적조사한 결과, 극돌기간 확장기 삽입술을 시행한 환자들에 비해 개복 감압술을 시행한 환자들이 모든 평가항목에서 우수한 결과를 보였습니다.



*Title: Percutaneous interspinous spacer versus open decompression: a 2-year follow-up of clinical outcome and quality of life.
극돌기간 경피적 확장기 삽입술 대 개복 감압술: 2년간의 임상적 결과와 삶의 질 추적조사

*Author: Beyer F, Yagdiran A, Neu P, Kaulhausen T, Eysel P, Sobottke R.




PURPOSE
-To compares the effectiveness of Percutaneous interspinous stand-alone spacers and open decompressive surgery.

-To determine the validity of using percutaneous interspinous spacer.



METHODS
Study type: Open prospective non-randomized study

Inclusion criteria: symptomatic lumbar stenosis between L3 and L5
Exclusion criteria: undergone previous surgery at the investigated level

Subject number: 45 patients

Divided 2 groups
-Group 1: underwent percutaneous interspinous stand-alone spacers (n = 12)
-Group 2: underwent bilateral open microsurgical decompression (n = 33)

Evaluation parameter:
1. patient data (using “Spine Tango” register; data collecting system)
2. operative report (contains disease, surgery information, complications)
3. Core Outcome Measures Index (COMI)**
4. SF-36 :Physical Component Summaries(PCS)**, Mental Momponent Summaries(MCS)**
5. Oswestry Disability Index (ODI)
6. Visual Analog Scale (VAS)
7. walking distance

Follow-up time: 6 weeks, 3, 6, 9, 12, 24 months post-surgery



RESULTS (after 2 yrs)
Revision -In group1: 5patients required implant removal and open decompression
                - In group2: none

Blood loss: group1<500ml
          500ml<group2<1000ml

Average speed of walking tolerance: 1.5km/h (improved for both groups)

Clinical outcome(VAS, ODI): group 1<group 2

Quality Of Life(SF-36-PCS/MCS): group 1<group 2



CONCLUSION
-Decompression proved superior to percutaneous stand-alone spacer implantation in our two observational cohorts.

-Recommend Interspinous spacer implantation only within randomized controlled trials for the collection of reliable data and conclusions for the spine surgeon.