Alessandro Cianfoni, Abstract Co-Author: Nothing to Disclose

Giuseppe Bonaldi MD, Presenter: Nothing to Disclose

To assess the safety, feasibility, and effectiveness of posterior vertebral arch cement augmentation in preventing delayed spinous processes’ fracture after interspinous spacer device implant, for the treatment of intermittent neurogenic claudication, in patients with risk factors for fragility fractures.

From June 2007 to March 2010, we implanted interspinous spacers in 35 eligible patients with risk factors for fragility fractures. In 19 of them, treated after April 2009, after assessment of the theoretical biomechanical effects of cement augmentation of the laminae by finite elements analysis, a percutaneous cement augmentation of the posterior vertebral arch (laminoplasty) was also performed. Clinical and radiological follow-up ranged between 3 and 14 months after the intervention.

No intra-procedural spinous processes nor laminar fractures were observed in either groups, and no patient in the 24-hour post-operative period suffered of any symptom possibly related to the procedure. A symptomatic delayed spinous process fracture was diagnosed in 4 out of 16 patients who did not undergo laminoplasty (25.0%), while no fractures were diagnosed in the 19 treated patients (p=0.035).

Intralaminar cement injection is feasible and safe. It has a biomechanical rationale, as demonstrated by a finite elements analysis. In our preliminary experience, it seems effective in preventing delayed fractures of the posterior arch post-interspinous spacer placement, in patients at risk for fragility fractures. These patient have a significant risk of developing a symptomatic delayed spinous processes’ fracture if not treated with posterior arch cement augmentation.

Cement augmentation of the spinous processes and laminae prior to interspinous spacer placement might prevent fracture and broaden this treatment to patients normally excluded from it

Cianfoni, A, Bonaldi, G, Posterior Vertebral Arch Cement Augmentation (Laminoplasty) to Prevent Fracture of Spinous Processes after Interspinous Spacer Implant.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11011065.html