A modified technique of interspinous ligamentoplasty for lumbar stenosis or degenerative spondylolisthesis
Ho-Yeon Lee1, Sang Bum Chang2, Sang-Ho Lee1, Song-Woo Shin1
1Departments of Neurosurgery, Wooridul Spine Hospital, Seoul, Korea
2Departments of Orthopedic Surgery, Wooridul Spine Hospital, Seoul, Korea
Keywords: Intervertebral disk displacement/surgery; lumbar vertebrae/surgery/radiography; spinal fusion/instrumentation/methods; spinal stenosis/surgery; spondylolisthesis/surgery.
Objectives: Interspinous ligamentoplasty (ILP) was first introduced by Senegas for the treatment of degenerative lumbar disease. The purpose of this study was to present a modified technique of ILP for lumbar stenosis or degenerative spondylolisthesis.
Patients and methods: Twenty patients (4 men, 16 women; mean age 61.3 years; range 31 to 83 years) underwent ILP after posterior decompression. Ten patients had stenosis with instability, eight patients had degenerative spondylolisthesis, and two patients had a juxtafacet cyst. The authors modified the original Senegas ILP procedure, so called the figure of '8' technique, as the '80 to 88' technique. In this modification, a second circular artificial ligament is added turning around the upper and lower spinous processes, initially resembling the figure '0'. It is then fastened in the middle so that its appearance turns to the figure '8'. Hence, the ligamentoplasty procedure is composed of two artificial ligaments both resembling the figure '8".
Results: At the end of a mean follow-up period of 17.4 months (range 1 to 45 months), the mean Ostwestry Disability Index score improved from 66% (range 26% to 88%) preoperatively to 31.1% (range 4% to 56%). Two patients developed superficial wound infection and another two developed transient dysesthesia. None of the patients required reoperation.
Conclusion: Considering relatively short operation time, less invasiveness, and its nonfusion nature, ILP with '80 to 88' technique seems to be an appropriate option for dynamic stabilization in treating degenerative pathologies. Yet, it should be justified with long-term comparative studies.