Interspinous process spacers versus traditional decompression for lumbar spinal stenosis: systematic review and meta-analysis

BACKGROUND: Interspinous spacers are used in selected patients for the treatment of lumbar spinal stenosis. The uses of interspinous devices are still debated, with reports of significantly higher reoperation rates and unfavourable cost-effectiveness compared to traditional decompression techniques. METHODS: Six electronic databases were searched from their date of inception to December 2015. Relevant studies were identified using specific eligibility criteria and data was extracted and analyzed based on predefined primary and secondary endpoints. RESULTS: Eleven comparative studies were obtained for qualitative and quantitative assessment, data extraction and analysis. There was no significant difference in VAS back pain, leg pain or ODI scores for standalone interspinous process device (IPD) vs. bony decompression. However, standalone IPD was associated with lower surgical complications (4% vs. 8.7%, P=0.03) but higher long-term reoperation rates (23.7% vs. 8.5%, P<0.00001). IPD as an adjunct to decompression had comparable patient-reported scores, complications and reoperation rates to decompression alone. CONCLUSIONS: Current evidence indicates no superiority for mid- to long-term patient-reported outcomes for IPD compared with traditional bony decompression, with lesser surgical complications but at the risk of significantly higher reoperation rates and costs.