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Meta-Analysis
. 2014 May 8;9(5):e97142.
doi: 10.1371/journal.pone.0097142. eCollection 2014.

Interspinous spacer versus traditional decompressive surgery for lumbar spinal stenosis: a systematic review and meta-analysis

Ai-Min Wu  1 , Yong Zhou  2 , Qing-Long Li  1 , Xin-Lei Wu  3 , Yong-Long Jin  1 , Peng Luo  1 , Yong-Long Chi  1 , Xiang-Yang Wang  1
Affiliations
Meta-Analysis

Interspinous spacer versus traditional decompressive surgery for lumbar spinal stenosis: a systematic review and meta-analysis

Ai-Min Wu et al. PLoS One. .

Abstract

Background: Dynamic interspinous spacers, such as X-stop, Coflex, DIAM, and Aperius, are widely used for the treatment of lumbar spinal stenosis. However, controversy remains as to whether dynamic interspinous spacer use is superior to traditional decompressive surgery.

Methods: Medline, Embase, Cochrane Library, and the Cochrane Controlled Trials Register were searched during August 2013. A track search was performed on February 27, 2014. Study was included in this review if it was: (1) a randomized controlled trial (RCT) or non-randomized prospective comparison study, (2) comparing the clinical outcomes for interspinous spacer use versus traditional decompressive surgery, (3) in a minimum of 30 patients, (4) with a follow-up duration of at least 12 months.

Results: Two RCTs and three non-randomized prospective studies were included, with 204 patients in the interspinous spacer (IS) group and 217 patients in the traditional decompressive surgery (TDS) group. Pooled analysis showed no significant difference between the IS and TDS groups for low back pain (WMD: 1.2; 95% CI: -10.12, 12.53; P = 0.03; I2 = 66%), leg pain (WMD: 7.12; 95% CI: -3.88, 18.12; P = 0.02; I2 = 70%), ODI (WMD: 6.88; 95% CI: -14.92, 28.68; P = 0.03; I2 = 79%), RDQ (WMD: -1.30, 95% CI: -3.07, 0.47; P = 0.00; I2 = 0%), or complications (RR: 1.39; 95% CI: 0.61, 3.14; P = 0.23; I2 = 28%). The TDS group had a significantly lower incidence of reoperation (RR: 3.34; 95% CI: 1.77, 6.31; P = 0.60; I2 = 0%).

Conclusion: Although patients may obtain some benefits from interspinous spacers implanted through a minimally invasive technique, interspinous spacer use is associated with a higher incidence of reoperation and higher cost. The indications, risks, and benefits of using an interspinous process device should be carefully considered before surgery.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Flowchart of the study selection process.
Figure 2
Figure 2. Forest plot showing the meta-analysis of visual analogue scale (VAS) scores for low back pain (A) and leg pain (B), the Oswestry disability index (C), and the Roland disability questionnaire (D).
Figure 3
Figure 3. Forest plot showing the meta-analysis for the incidence of complications.
Figure 4
Figure 4. Forest plot showing the meta-analysis for the reoperation rate.
See this image and copyright information in PMC

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