Abstract

GUIMBARD PEREZ, Joint Halley; POMBA, Mariano; GONZALEZ, Gustavo A  and  ORTIZ, Nicolás. Dispositivos interespinosos en discectomías lumbares primarias: ¿Favorecen la recurrencia de la hernia de discos?. Rev. Asoc. Argent. Ortop. Traumatol. [online]. 2019, vol.84, n.2, pp.106-111. ISSN 1852-7434.

Objective: The objective of this study was to determine if discectomy with placement of an interspinous DIAM silicon spacer is associated with a different rate of clinical and radiological recurrent ipsilateral disc herniation compared to discectomy alone. Methods: A prospective, observational, randomized study was performed from May 2009 to May 2013 at our center. Of the 123 patients included in the study, 3 were lost to follow-up, leaving 120 patients for data analysis. All patients were operated on by the same surgical team. Patients received one of two types of treatment. Group A consisted of 30 patients (16 women and 14 ment) who underwent discectomy with placement of an interspinous DIAM silicone spacer. Group B was comprised of 90 patients (53 women and 37 men) treated by discectomy alone. Results: Discectomy at L4-L5 level was the most common approach, being performed in 90% (27) of Group A patients and 80% (72) of Group B patients. Group A demonstrated clinical and radiological recurrent disc herniation in 6/30 (20%) patients. Recurrent disc herniation developed in 4/90 (4.4%) of Group B patients. One patient underwent surgical revision (1.1%). Both recurrence and surgical revision were significantly higher in Group A (p = 0.007 and p = 0.019, respectively). Conclusions: The benefits of interspinous devices for the treatment of the lumbar spinal stenosis secondary to disc herniation are controversial, and this study showed a significant intergroup difference. In this study, patients that underwent discectomy and interspinous spacer placement had higher revision and recurrence rates than discectomy patients that did not receive an interspinous spacer. Interspinous spacers may increase the rate of disc herniation by preserving movement at the level of the original disc herniation and changing the physiologic load. Further studies are needed to corroborate and evaluate these trends.

Keywords : Lumbar discectomy; Interspinous spacer; Recurrent disc herniation.

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