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Spinous Process Distraction with Allograft in the Treatment of Spondylolisthesis with Spinal Stenosis

1 August 2006


For many years the standard treatment for symptomatic degenerative spondylolisthesis and spinal canal stenosis has been lumbar decompression and spinal fusion to decompress the nerve roots and/or spinal cord and to stabilize the spine. In recent years, several different methods have been devised as alternative treatments for degenerative spondylolisthesis and spinal stenosis. One of these is known as spinous process distraction (SPD) in which the spinous processes are mechanically pushed apart or distracted. This distraction relieves pressure on the spinal cord and/or nerve roots that is caused by the spondylolisthesis and spinal stenosis. The overall goals of traditional lumbar decompression with lumbar fusion and SPD are the same in that they both aim to relieve lower extremity neuropathy and claudication and may alleviate low back pain. SPD may offer some advantage in that it is not as invasive as lumbar decompression and spinal fusion. This may lead to faster recovery times, better functional outcomes, fewer complications, shorter surgery times, decreased blood loss during the operations, and shorter length of stay in the hospital. Patients suffering from degenerative spondylolisthesis and spinal stenosis are usually treated with lumbar decompression and fusion if conservative therapy such as nonsteroidal anti-inflammatories (NSAIDS) and epidural steroid injections do not relieve their symptoms. However, many patients have comorbidities that make them less than perfect surgical candidates. The focus of this study was to determine if spinous process distraction with allograft is a procedure that will provide satisfactory outcomes for patients not responding to conservative therapy and who are poor surgical candidates. The results may help surgeons determine if SPD with allograft may be an acceptable option that will provide satisfactory outcomes in patients that are refractory to conservative therapies and unfit candidates for lumbar decompression and fusion. The results of the study showed that SPD with allograft provided effective short-term pain relief and increased functional capacity in the group of subjects examined.


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