Editorials

Surgery for neurogenic claudication and spinal stenosis

BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f6930 (Published 20 November 2013) Cite this as: BMJ 2013;347:f6930
  1. Jeremy Fairbank, professor of spinal surgery
  1. 1Nuffield Orthopaedic Centre, University of Oxford, Oxford OX3 7HE, UK
  1. jeremy.fairbank{at}ndorms.ox.ac.uk

Time to think again about controversial (and costly) interspinous devices

A linked paper (doi:10.1136/bmj.f6415) by Moojen and colleagues reports on a well executed randomised controlled trial in the Netherlands that compared two treatment options for adults with neurogenic claudication secondary to spinal stenosis.1 The researchers randomised 159 adults with lumbar stenoses at one or two vertebral levels into two groups. One group was treated with conventional decompressive surgery and the other with an interspinous spacer. Moojen and colleagues found little difference in a range of outcomes between the groups, although those treated with a spacer were significantly more likely to need revision surgery than those treated with conventional surgery (29% v 8%). A similarly high revision rate after treatment with interspinous spacer devices was recently reported in a trial from Sweden.2

Spinal stenosis, or narrowing of the vertebral canal, was first described in English in 1954 by a Dutch neurosurgeon.3 He made the important distinction between “developmental” (seen in achondroplasia but also in normal people) and “degenerative” stenosis (secondary to distortion of the normal anatomy by disc degeneration). Two years later, Blau and Logue coined the term neurogenic claudication for the syndrome linked to spinal stenosis.4 The advent of whole body imaging (computed tomography and then magnetic resonance imaging) …

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