Spinal Stenosis and Listhesis Treated With Percutaneous Interspinous Spacer: a Non-surgical Trial

University of Roma La Sapienza200 enrolled

Overview

Symptomatic lumbar spinal stenosis is the most common indication for spinal surgery. However, more than one-third of the patients undergoing surgery for lumbar stenosis report dissatisfaction with the results. On the other hand, conservative treatment has shown positive results in some cases. This trial will compare the outcomes of surgical versus non-surgical treatment for lumbar stenosis.

This is a three-centre randomised controlled trial in which 200 patients with symptomatic lumbar spinal stenosis will be randomised into one of two treatment arms. The patients in the surgical arm will undergo decompression of the neural structures by use of any open or minimally invasive (MIS) technique with or without fusion; the patients in the non-surgical arm will undergo imaging assisted percutaneous interspinous spacer insertion with fusion. The primary outcome of the study will be the Oswestry Disability Index. Secondary outcomes will include motor amplitude and degree of denervation activity obtained by means of nerve conduction studies and electromyography. Patient-reported outcome measures will be also used as secondary outcomes.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Enrollment

200

Conditions

Lumbar Spine Degeneration Lumbar Spine Instability

Eligibility

Sex: ALLMin age: 50 YearsMax age: 85 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. Age 50-85 years. 2. Clinical symptoms of lumbar spinal stenosis (pseudoclaudication) indicating and motivating surgery. Numeric Rating Scale in lower limbs ≥3. 3. MRI with finding of lumbar spinal stenosis at 1-3 lumbar levels. Dural sac area ≤75 mm2 or degree of stenosis C or D according to Schizas's classification.34 4. The patient has given oral and written informed consent to participate. Exclusion Criteria: 1. Degenerative deformity with Cobb angle \>20°. 2. Symptomatic osteoarthritis in the lower limbs that affects and limits the patient's function. 3. Arterial insufficiency (claudication intermittent). 4. Former lumbar surgery other than disc hernia. 5. Conditions that affect the spine, such as ankylosing spondylitis, diffuse idiopathic skeletal hyperostosis, spondylodiscitis/infections, malignancy and neurological diseases. 6. Heart and lung diseases presenting a significant risk for surgery or making it impossible for the patient to take part in a percutaneous arm of treatment (American Society of Anesthesiologists (ASA) score \>3). 7. Polyneuropathies. 8. Psychological factors rendering the patient incapable of inclusion in the trial (eg, drug addiction, dementia).

Outcomes

Primary Outcomes

oswestry disability Index

system based on a % scale, with higher scores indicating greater disability; clinically important difference to improvement: 10%

Time frame: 26 weeks

oswestry disability Index

system based on a % scale, with higher scores indicating greater disability; clinically important difference to improvement: 10%

Time frame: 52 weeks

Secondary Outcomes

Euro Quality of life Five-Dimensional descriptive system questionnaire (EQ-5D)

Time frame: 26 and 52 weeks

Numeric Rating Scale (NRS)

for low back and leg pain (0-10 being 10 worst)

Time frame: 26 and 52 weeks

subjective walking ability tool

Time frame: 26 and 52 weeks

neurophysiological measurements (NCSs/EMG)

Time frame: 52 weeks

Spinal Stenosis and Listhesis Treated With Percutaneous Interspinous Spacer: a Non-surgical Trial

Overview

Conditions

Interventions

Eligibility

Locations (1)

Outcomes

Primary Outcomes

Secondary Outcomes

Central Contacts