A New Monolaterally Inserted Interspinous Device in the Mini- Invasive Surgical Treatment of Lumbar Disc Herniation associated with Lumbar Canal Stenosis M. Fricia, M. Passanisi, F. Inserra, F. Barone, G. Distefano, P. Seminara, F. Ventura U.O.C. Neurosurgery Director: Prof. Fausto Ventura A. O. “Cannizzaro” Catania - Italy XIV World Congress of WFNS Boston, MA August 30 – September 4, 2009

INTRODUCTION Interspinous devices are a new mini-invasive method of surgical treatment for several lumbar spine disorders The indications for positioning of these devices are currently lumbar spinal stenosis, grade 1 spondylolisthesis, axial-load induced back pain, facet syndrome, degenerative and/or iatrogenic (post- discectomy) disc syndrome, unloading of disc adjacent to a lumbar fusion procedure, primary or secondary

INTRODUCTION Medically non-responders patients with stable or worsening diseases and evident lumbar disc herniation with associated just slight local or above- and down-located stenosis are surgically treated just by removing disc herniation Post-operative results depending on selected patients and different surgical techniques are, when successful, stable but burdened by recurrence or prevalent lumbar stenosis syndrome. In these cases we describe our preliminary experience with a new interspinous device, monolaterally-inserted and easy to use after microdiscectomy

METHODS During one-year time 27 patients (Group B) were so treated and compared with other 31 only microdiscectomy-treated patients (Group A) The treated levels were L3/L4, L4/L5, L5/S1 Clinical assessment was done before and after surgery by Oswestry Disability Index (ODI) and Visual Analogous Scale (VAS)

This new interspinous devices features of a Spacer of Peek (polyetheretherketone) and titanium hinge TECHNIQUE

POST MICRODISCECTOMY DILATATE SIZEIMPLANT

Microdiscectomy + interspinous device L4/L5

Microdiscectomy + interspinous device L4/L5 – L5/S1

RESULTS Follow-up one year Oswestry Score Group A = 59,8% (before surgery) → 13,9% (after surgery) Oswestry Score Group B = 58,3% (before surgery) → 8,7% (after surgery) VAS score no statistically significant differences in the both group

RESULTS Preliminary our data suggest a faster improvement in device- treated patients with no disc herniation recurrence Evaluation of levels did not reveal any statistically significant differences No perioperative/postoperative complications

CONCLUSIONS Although our data are not statistically significant, due to the small number of patients, we may predict a better clinical result with this particular device in selected patients presenting such associated conditions