Decompression and Coflex interlaminar stabilization compared with decompression and instrumented spinal fusion for spinal stenosis and low-grade degenerative spondylolisthesis

Brief review

*Title: Decompression and Coflex interlaminar stabilization compared with decompression and instrumented spinal fusion for spinal stenosis and low-grade degenerative spondylolisthesis

:two-year results from the prospective, randomized, multicenter, Food and Drug Administration Investigational Device Exemption trial.

요추 협착증과 낮은 단계의 퇴행성 척추전방전위증 치료를 위한 감압술 & Conflex(고정체)를 이용한 추궁간판 안정화술과 감압술 & 요추유합술 비교.

:전향적, 무작위배정, 다기관, FDA-IDE연구

*Authors: Davis RJ, Errico TJ, Bae H, Auerbach JD.

*Bibliography: Spine (Phila Pa 1976). 2013Aug 15;38(18):1529-39.

STUDY DESIGN

Prospective, randomized, multicenter, Food and Drug Administration Investigational Device Exemption trial (FDA- IDE)

OBJECTIVE

To evaluate the safety and efficacy of Coflex interlaminar stabilization compared with posterior spinal fusion in the treatment of 1- and 2-level spinal stenosis and degenerative spondylolisthesis.

SUMMARY OF BACKGROUND DATA

Lumbar fusion for stenosis and degenerative spondylolisthesis have led to the search for motion-preserving, less-invasive alternatives.

METHODS

▶Subject: total 322 patients (2006~2010)

-Randomized to receive laminectomy & Coflex interlaminar stabilization(215) or laminectomy & posterolateral spinal fusion(107)   -->2:1 ratio

▶Evaluating methods: ODI, reoperations, complications, postoperative epidural injections

RESULTS

▶Follow-up: 95.3% (Coflex) / 97.2% (fusion) –min 2 yrs.

▶Results:

-Operative times: conflex < fusion

- blood loss: conflex < fusion

- length of stay: conflex < fusion

-ODI improvement: conflex > fusion

-VAS improvement: both groups

-SF-12 improvement: conflex > fusion

-Zurich Claudication Questionnaire

-Reoperation rate: conflex (10.7%) > fusion (7.5%) (p = 0.426)

-Overall success rate: Coflex (66.2%) > fusion (57.7%) (p = 0.999) -Based on the FDA.

>Coflex significantly improve in all outcomes measures compared with fusion: symptom severity (p = 0.023); physical function (p = 0.008); satisfaction (p = 0.006)

>At 2 yrs, fusions increased angulation (P = 0.002) and a trend toward increased translation (p= 0.083) at the superior adjacent level. Whereas Coflex maintained normal operative and adjacent level motion.

CONCLUSION

Coflex interlaminar stabilization is a safe and efficacious alternative compared with lumbar spinal fusion for spinal stenosis and low-grade spondylolisthesis.