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首页> 外文期刊>Pain medicine : >A Review of Emerging Evidence for Utilization of a Percutaneous Interspinous Process Decompression Device to Treat Symptomatic Lumbar Adjacent-Segment Degeneration
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A Review of Emerging Evidence for Utilization of a Percutaneous Interspinous Process Decompression Device to Treat Symptomatic Lumbar Adjacent-Segment Degeneration

机译：审查新兴依赖性偶然流程减压装置治疗症状腰部相邻段变性的证据

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Objective. Postlaminectomy syndrome diagnoses secondary to adjacent segment degeneration are a substantial and rising cause of morbidity in the United States. Emerging spinal cord neuromodulation technologies have produced successful outcomes for postlaminectomy neuropathic pain but are less effective in treating neurogenic claudication secondary to recurrent lumbar stenosis. Percutaneous interspinous process decompression systems can be used as a salvage treatment modality for persistent structural neurogenic claudication in postlaminectomy syndrome or after spinal cord stimulator implantation. Methods. This paper is a review of emerging evidence for efficacious utilization of percutaneous interspinous process decompression. Results. A recent pragmatic trial of subjects who underwent percutaneous interspinous process decompression for lumbar stenosis with intermittent neurogenic claudication reported that 63% (26/41) maintained minimal clinically important improvement in visual analog scale (VAS) leg pain, 61% (25/41) in VAS back pain, 78% (32/41) in function objective values, and 88% (36/41) reported satisfaction with treatment at 12 months postop. All subjects in a small case series of seven individuals with postlaminectomy adjacent-segment disease reported postoperative satisfaction scores of 3 or 4 on a 0-4 scale and were also able to decrease or wean completely off controlled pain medications. In another study, there was a significant decrease in average leg pain (60% improvement, P<0.0001, N = 25) and axial low back pain (58% improvement, P<0.0001, N = 25) in patients who underwent one- or two-level percutaneous interspinous process decompression as a rescue treatment for reemerging neurogenic claudication after spinal cord stimulator implantation. Conclusions. The spine often is a focus of progressive disease. Furthermore, mechanical changes associated with spinal instrumentation can lead to additional disease at adjacent levels. Many individuals will present with symptomatic neurogenic claudication recalcitrant to multimodal management strategies, including even the most sophisticated neuromodulation technologies. Implementation of salvage percutaneous interspinus process decompression implantation in cases of adjacent segment degeneration or incomplete spinal cord stimulation can decompress structural causes of neurogenic claudication while sparing the patient from more invasive surgical reoperation techniques.
机译：客观的。后粘膜切除术综合征诊断为相邻的段变性是美国发病率的重大和上升原因。出现的脊髓神经调节技术为突出的术后神经性疼痛产生了成功的结果，但在治疗继发性腰椎狭窄的神经源性跛行方面都不效益。经皮的梭菌过程减压系统可用作粘膜切除综合征或脊髓刺激器植入后持久性结构神经源性跛行的挽救治疗方式。方法。本文是对新兴证据的综述，用于有效利用经皮梭菌的过程减压。结果。近期对受经皮梭菌过程减压进行腰部狭窄的受试者的务实试验报告说，63％（26/41）在视觉模拟规模（VAS）腿部疼痛中保持最小的临床重要改善，61％（25/41）在VAS背部疼痛中，78％（32/41）的函数目标值，88％（36/41）报告在第12个月后治疗的满意度。所有受试者在一个小案例系列七个具有突出的术后分段疾病，报告了0-4规模的术后满意度3或4分，并且还能够缩小或干扰受控止痛药。在另一项研究中，平均腿部疼痛的显着降低（60％改善，P <0.0001，N = 25）和轴向低腰疼痛（58％改善，P <0.0001，N = 25），患者接受了一个 - 或两级经皮的梭菌过程减压作为脊髓刺激物植入后重新改造神经源性跛行的救援治疗。结论。脊柱通常是渐进疾病的焦点。此外，与脊柱仪器相关的机械变化可导致相邻水平的额外疾病。许多人将呈现对症状神经源性跛行顽固的多式联管理策略，包括甚至最复杂的神经调节技术。在相邻分析变性或不完全脊髓刺激的情况下，挽救经皮的过程减压植入可以减压神经源性跛行的结构原因，同时从更多侵入性外科再次操作技术施用患者。

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