Interlaminar Stabilization May Have Edge in Elderly With Lumbar Stenosis

By David Douglas

July 29, 2020

NEW YORK (Reuters Health) - Interlaminar stabilization (ILS), an intermediary between decompression alone and decompression with fusion, may offer relief in older patients with low-back pain when conservative treatment fails, according to New York City-based researchers.

As Dr. Celeste Abjornson of the Hospital for Special Surgery told Reuters Health by email, "Interlaminar stabilization offers a durable, minimally invasive technique to improve clinical outcomes over the classical standard of decompression."

"Similar to an instrumented fusion," she added, "ILS provides sustained relief of the neural elements, however it also offers motion preservation that can have significant benefits to the global spinal segment."

In a post-hoc analysis of data from the IDE trial, Dr. Abjornson and colleagues studied patients with moderate lumbar stenosis who had been randomized 2:1 to decompression with ILS or with posterolateral fusion with bilateral pedicle screw instrumentation.

Overall, 215 patients had ILS (including 84 who were at least 65 years old) and 107 had fusion (including 57 who were aged 65 or older).

Preoperatively all had reported significant pain and disability. They were assessed before and six weeks after surgery and at intervals of up to 60 months.

At 24 and 60 months, there were no significant differences in measures of overall clinical success across groups, the researchers report in The Spine Journal. This was also true of radiographic findings and postoperative narcotic usage.

Moreover, "there were no statistically significant differences . . . regarding patient satisfaction and patient recommendation of the same treatment," the team writes.

However, older patients who underwent ILS rather than fusion had a shorter mean operative time (100 vs. 153 minutes), a lower estimated mean blood loss (106 vs. 358 cc) and a shorter mean hospital stay (2.07 vs. 3.30 days), all significant differences.

When compared with the younger ILS patients, the older ILS group had a significantly longer mean hospital stay, but there were no significant differences in mean operative time or estimated blood loss.

The researchers note, "Although a cost analysis was not performed for this specific study, the reduction in operative time, blood loss and hospital stay from using ILS compared to fusion can infer an improvement regarding the risk of complications and, furthermore, the related cost of surgery."

They concede that the study population was small, but say the "results confirm the sustainability and durability of ILS as an effective, efficacious treatment for older patients undergoing surgery for lumbar spinal stenosis with or without mild spondylolisthesis."

SOURCE: The Spine Journal, online July 10, 2020.