The reoperation of Coflex dynamic interspinous stabilization system in the treatment of lumbar degenerative disease

English Keywords:Interspinous process device  Lumbar  Reoperation  Spinal stenosis  Intervertebral disc degeneration

English Abstract:

  【Abstract】 Objectives: To evaluate the rate of revision surgery after posterior Coflex interspinous dynamic stabilization for lumbar spine degenerative disorders, and to discuss its causes and management. Methods: From September 2007 to July 2015, 295 patients with the degenerative disorders of lumbar spine were treated with decompression and Coflex interspinous dynamic stabilization in our hospital. In order to evaluate the rate of revision surgery among these patients and discuss its causes and management, a retrospective study was conducted and all patients were surgically treated and followed up to evaluate the clinical outcome based on patient satisfaction. Results: Among 295 patients in this study, there were 16 patients undergoing revision surgery and the total rate of reoperation was 5.4%. The duration between revision procedure and primary procedure was 15.1±23.4 months(range, 0.1-60 months) in these patients. Among the 16 patients, 6 patients(37.5%) had non-implant related complications including the infection of wound or local hemotoma. All these 6 patients healed after debridement or hematoma removal. Another 10 patients(62.5%) underwent reoperation due to implant related complications. There were two patients who had topping-off procedure initially developed pedicle screw loosening or nerve root adhesion and were treated with the reimplantation of fixation. Another 8 patients who had single level Coflex dynamic stabilization developed symptoms of deterioration of previous segment or adjacent segment. Those patients were managed with decompression and fusion with pedicle screw fixation. None of the 16 patients had the Coflex related problem such as the migration, loosening or dislocation of Coflex implant and the fracture of the spinous process. These patients were followed up for 28.6±12.6 months(range, 6-48 months) and 93.8% of the patients were satisfied with the revision surgery at the final follow-up. Conclusions: Coflex interspinous dynamic stabilization for the treatment of degenerative disorders of the lumbar spine is safe and the reoperation rate is low. The main cause of revision surgery including wound infection, local hemotoma, degeneration at previous segment or adjacent segment is not directly related to Coflex implant itself.