Study design:
Retrospective cohort analysis.
Objective:
To compare postoperative outcomes of Coflex interspinous device versus laminectomy.
Summary of background data:
Coflex Interlaminar Stabilization ® device (CID) is indicated for one- or two-level lumbar stenosis with grade 1 stable spondylolisthesis in adult patients, as an alternative to laminectomy, or laminectomy and fusion. CID provides stability against progressive spondylolisthesis, retains motion, and prevents further disc space collapse.
Methods:
Patients ≥18 years-old with lumbar stenosis and grade 1 stable spondylolisthesis who underwent either primary single-level decompression and implantation of CID; or single-level laminectomy alone were included with a minimum 90 day follow up at a single academic institution. Clinical characteristics, perioperative outcomes, and postoperative complications were reviewed until the latest follow-up. Chi-square and independent samples t tests were used for analysis.
Results:
83 patients (2007-2019) were included: 37 cases of single-level laminectomy (48.6% female) were compared to 46 single-level CID (50% female). CID cohort was older (CID 69.0 ± 9.4 vs Laminectomy 64.2 ± 11.0, p = 0.042) and had higher American Society of Anesthesiologists (ASA) grade (CID 2.59 ± 0.73 vs Laminectomy 2.17 ± 0.48, p = 0.020). CID patients had higher estimated blood loss (97.50 ± 77.76 vs 52.84 ± 50.63 mL, p = 0.004), longer operative time (141.91 ± 47.88 vs 106.81 ± 41.30 min, p = 0.001), and longer length of stay (2.0 ± 1.5 vs 1.1 ± 1.0 days, p = 0.001). Total perioperative complications (21.7% vs 5.4%, p = 0.035) and instrumentation related complication was higher in CID (10.9% vs 0% laminectomy group, p = 0.039). There were no other significant differences between the groups in demographics or outcomes.
Conclusion:
Single level CID devices had higher perioperative 90-day complications, longer operative time, length of stay, higher estimated blood loss compared to laminectomies alone. Similar overall revision and neurologic complication rates were noted compared to laminectomy at last follow up.Level of Evidence: 3.