PERCUTANEOUS INTERSPINOUS DEVICES TREATMENT IN PATIENTS AFFECTED BY LUMBAR SPINAL CANAL STENOSIS: A PRELIMINARY STUDY EVALUATING DURAL SAC USING WEIGHT BEARING MRI, BEFORE AND AFTER THE TREATMENT

L. Manfrè¹, E.A. De Vivo¹, C. Zini², F. Ventura¹ and J.A. Hirsch³

¹Department of Radiology, IOM Mediterranean Oncology Institute, Viagrande, Italy;
²UO Radiologia, Ospedale Santa Maria Annunziata USL Toscana Centro, Firenze, Italy;
³NeuroEndovascular Program, Massachusetts General Hospital, Boston, Massachusetts, USA

Correspondence to:
Luigi Manfrè, MD
Department of Radiology,
IOM Mediterranean Oncology Institute,
Viagrande, Italy
e-mail: lmanfre@me.com

Received: 14 November 2023 Accepted: 03 January 2024

ISSN 2975-044X (online) ISSN 2038-4106 (print) Copyright © by BIOLIFE 2024 This publication and/or article is for individual use only and may not be further reproduced without written permission from the copyright holder. Unauthorized reproduction may result in financial and other penalties. Disclosure: All authors report no conflicts of interest relevant to this article.

ABSTRACT

Lumbar Spinal Canal and Foraminal Stenosis is a widely diffuse pathological condition responsible for neurogenic claudication. Conventional MRI study may underestimate the disease. Percutaneous interspinous devices (IPD) has been proposed when significant real stenosis occurs. To evaluate the real stenosis rate before and after the treatment in  a population of 72/210 patients affected by symptomatic Lumbar Spinal Canal Stenosis (LSCS) and/or Lumbar Spinal Foramina Stenosis (LSFS) treated with percutaneous IPD in patients were evaluated by weight-bearing MRI using semi-automatic AI analysis. Seventy-two of a population of 210 patients eligible for IPD treatment underwent a Weight-Bearing MRI (WB-MRI) lumbar study the day before and one month after the surgical procedure. All the patients underwent percutaneous CT/Fluoro-guided IPD implant. Minimum Clinically Important Difference (MCID), Zurich Claudication Questionnaire (ZCQ) and Oswestry Disability Index (ODI) score was rated. Fifty-two out of 210 patients (25% of the study population) became eligible for IPD surgery because of LSCS grading increased on weight-bearing MRI images only, as well as occult listhesis, detected in 21/210. Ratio improvement of the dural sac diameter was statistically significant in all the patients treated in the supine position (ratio 2.0, 95% CIs 1.58, 2.41) and standing position (ratio 3.13, 95% CIs 1.89, 4.37). WB-MRI is the best way to depict true dural sac size before and after IPD implants. Post-IPD studies demonstrated a significant increase in the actual dural sac area after the treatment when immediate postoperative follow-up was performed, reaffirming the effectiveness of IPD in treating LSCS patients.

KEYWORDS: Weight-bearing MRI, Spinal Canal Stenosis, Interspinous device, spacer, spine treatment