{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T13:57:59Z","timestamp":1775743079382,"version":"3.50.1"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,3,16]],"date-time":"2022-03-16T00:00:00Z","timestamp":1647388800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Best practice guidelines for treating lumbar stenosis include a multidisciplinary approach, ranging from conservative management with physical therapy, medication, and epidural steroid injections to surgical decompression with or without instrumentation. Marketed as an outpatient alternative to a traditional lumbar decompression, interspinous process devices (IPDs) have gained popularity as a minimally invasive stabilization procedure. IPDs have been embraced by non-surgical providers, including physiatrists and anesthesia interventional pain specialists. In the interest of patient safety, it is imperative to formally profile its safety and identify its role in the treatment paradigm for lumbar stenosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case Description<\/jats:title><jats:p>We carried out a retrospective review at our institution of neurosurgical consultations for patients with hardware complications following the interspinous device placement procedure. Eight cases within a 3-year period were identified, and patient characteristics and management are illustrated. The series describes the migration of hardware, spinous process fracture, and worsening post-procedural back pain.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>IPD placement carries procedural risk and requires a careful pre-operative evaluation of patient imaging and surgical candidacy. We recommend neurosurgical consultation and supervision for higher-risk IPD cases.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fsurg.2022.841134","type":"journal-article","created":{"date-parts":[[2022,3,16]],"date-time":"2022-03-16T04:40:39Z","timestamp":1647405639000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":10,"title":["Neurosurgical Management of Interspinous Device Complications: A Case Series"],"prefix":"10.3389","volume":"9","author":[{"given":"T. J.","family":"Florence","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Irene","family":"Say","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kunal S.","family":"Patel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ansley","family":"Unterberger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Azim","family":"Laiwalla","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew C.","family":"Vivas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel C.","family":"Lu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,3,16]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"541","DOI":"10.3171\/2020.8.SPINE201205","article-title":"Editorial. Interspinous spacers for lumbar stenosis: time for obsolescence?","volume":"34","author":"Wang","year":"2021","journal-title":"J Neurosurg."},{"key":"B2","first-page":"265","article-title":"Interspinous process decompression (IPD) system (X-STOP) for the treatment of lumbar spinal stenosis","volume":"15","author":"Chiu","year":"2006","journal-title":"Surg Technol Int."},{"key":"B3","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1097\/00024720-200402000-00013","article-title":"An interspinous process distractor (X STOP) for lumbar spinal stenosis in elderly patients","volume":"17","author":"Lee","year":"2004","journal-title":"J Spinal Disord Techn."},{"key":"B4","doi-asserted-by":"publisher","first-page":"908","DOI":"10.1007\/s00586-005-0891-9","article-title":"Insertion loads of the X STOP interspinous process distraction system designed to treat neurogenic intermittent claudication","volume":"15","author":"Talwar","year":"2006","journal-title":"Eur Spine J."},{"key":"B5","doi-asserted-by":"publisher","first-page":"361","DOI":"10.2174\/1874325001105010361","article-title":"Minimally invasive treatment of moderate lumbar spinal stenosis with the superion interspinous spacer","volume":"5","author":"Bini","year":"2011","journal-title":"Open Orthop J."},{"key":"B6","doi-asserted-by":"publisher","first-page":"2943","DOI":"10.2147\/JPR.S182322","article-title":"Interspinous process decompression is associated with a reduction in opioid analgesia in patients with lumbar spinal stenosis","volume":"11","author":"Nunley","year":"2018","journal-title":"J Pain Res."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1409","DOI":"10.2147\/CIA.S143503","article-title":"Five-year durability of stand-alone interspinous process decompression for lumbar spinal stenosis","volume":"12","author":"Nunley","year":"2017","journal-title":"Clin Interv Aging."},{"key":"B8","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1016\/j.wneu.2017.04.163","article-title":"Superion interspinous spacer treatment of moderate spinal stenosis: 4-year results","volume":"104","author":"Nunley","year":"2017","journal-title":"World Neurosurg."},{"key":"B9","doi-asserted-by":"publisher","first-page":"28","DOI":"10.14444\/2028","article-title":"Cost-effectiveness of three treatment strategies for lumbar spinal stenosis: conservative care, laminectomy, and the Superion interspinous spacer","volume":"9","author":"Parker","year":"2015","journal-title":"Int J Spine Surg."},{"key":"B10","doi-asserted-by":"publisher","first-page":"657","DOI":"10.2147\/JPR.S92633","article-title":"Superion(\u00ae) InterSpinous Spacer for treatment of moderate degenerative lumbar spinal stenosis: durable three-year results of a randomized controlled trial","volume":"8","author":"Patel","year":"2015","journal-title":"J Pain Res."},{"key":"B11","doi-asserted-by":"publisher","first-page":"227","DOI":"10.2147\/CIA.S23656","article-title":"Minimally invasive treatment of lumbar spinal stenosis with a novel interspinous spacer","volume":"6","author":"Shabat","year":"2011","journal-title":"Clin Interv Aging."},{"key":"B12","doi-asserted-by":"publisher","first-page":"763","DOI":"10.1586\/17434440.2015.1100071","article-title":"Stand-alone interspinous spacer versus decompressive laminectomy for treatment of lumbar spinal stenosis","volume":"12","author":"Lauryssen","year":"2015","journal-title":"Expert Rev Med Devices."},{"key":"B13","doi-asserted-by":"publisher","first-page":"31","DOI":"10.21037\/jss.2016.01.07","article-title":"Interspinous process spacers versus traditional decompression for lumbar spinal stenosis: systematic review and meta-analysis","volume":"2","author":"Phan","year":"2016","journal-title":"J Spine Surg."},{"key":"B14","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1148\/radiology.207.2.9577486","article-title":"Lumbar spine: quantitative and qualitative assessment of positional (upright flexion and extension) MR imaging and myelography","volume":"207","author":"Wildermuth","year":"1998","journal-title":"Radiology."},{"key":"B15","doi-asserted-by":"publisher","first-page":"609","DOI":"10.1007\/s00586-011-1928-x","article-title":"Biomechanical analysis of the spino-pelvic organization and adaptation in pathology","volume":"20","author":"Roussouly","year":"2011","journal-title":"Eur Spine J."},{"key":"B16","doi-asserted-by":"publisher","first-page":"1530","DOI":"10.1097\/00007632-199607010-00008","article-title":"Measurement of lumbar lordosis. Evaluation of intraobserver, interobserver, and technique variability","volume":"21","author":"Polly DW","year":"1996","journal-title":"Spine."},{"key":"B17","first-page":"37","article-title":"Minimally invasive lumbar decompression for lumbar stenosis: review of clinical outcomes and cost effectiveness","volume":"59","author":"Johans","year":"2015","journal-title":"J Neurosurg Sci."},{"key":"B18","doi-asserted-by":"publisher","first-page":"E16","DOI":"10.3171\/2019.1.FOCUS18510","article-title":"A novel technique for awake, minimally invasive transforaminal lumbar interbody fusion","volume":"46","author":"Chan","year":"2019","journal-title":"Neurosurg Focus."},{"key":"B19","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1016\/j.clinthera.2015.11.016","article-title":"Dexmedetomidine-fentanyl compared with midazolam-fentanyl for conscious sedation in patients undergoing lumbar disc surgery","volume":"38","author":"Peng","year":"2016","journal-title":"Clin Ther."},{"key":"B20","doi-asserted-by":"publisher","first-page":"E91","DOI":"10.1097\/BRS.0000000000001161","article-title":"Minimally invasive versus open laminectomy for lumbar stenosis: a systematic review and meta-analysis","volume":"41","author":"Phan","year":"2016","journal-title":"Spine."},{"key":"B21","doi-asserted-by":"publisher","first-page":"423","DOI":"10.2147\/MDER.S220431","article-title":"Interspinous process decompression with the superion spacer for lumbar spinal stenosis: real-world experience from a device registry","volume":"12","author":"Tekmyster","year":"2019","journal-title":"Med Devices."},{"key":"B22","doi-asserted-by":"publisher","first-page":"e5374","DOI":"10.7759\/cureus.5374","article-title":"The use of Vertiflex\u00ae interspinous spacer device in patients with lumbar spinal stenosis and concurrent medical comorbidities","volume":"11","author":"Hartman","year":"2019","journal-title":"Cureus"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1","DOI":"10.52211\/asra110120.073","article-title":"How I do it: the Vertiflex\u00ae procedure for lumbar spinal stenosis","volume":"45","author":"Weisbein","year":"2020","journal-title":"ASRA News."},{"key":"B24","doi-asserted-by":"publisher","first-page":"561","DOI":"10.1136\/rapm-2019-101105","article-title":"Pain medicine: if we want to be surgeons, we must have surgical training","volume":"45","author":"Hagedorn","year":"2020","journal-title":"Reg Anesth Pain Med."},{"key":"B25","doi-asserted-by":"publisher","first-page":"2777","DOI":"10.2147\/JPR.S309705","article-title":"Interventional spine and pain procedure credentialing: guidelines from the american society of pain & neuroscience","volume":"14","author":"Naidu","year":"2021","journal-title":"J Pain Res."},{"key":"B26","doi-asserted-by":"publisher","first-page":"1","DOI":"10.14444\/8026","article-title":"Determination of work relative value units for management of lumbar spinal stenosis by open decompression and interlaminar stabilization","volume":"15","author":"Lorio","year":"2021","journal-title":"Int J Spine Surg."},{"key":"B27","unstructured":"Position Statement on Arthrodesis of the Spine by the Non-spine Surgeon2021"},{"key":"B28","doi-asserted-by":"publisher","first-page":"466","DOI":"10.1016\/j.spinee.2012.03.034","article-title":"Association between degenerative spondylolisthesis and spinous process fracture after interspinous process spacer surgery","volume":"12","author":"Kim","year":"2012","journal-title":"Spine J."},{"key":"B29","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/02688697.2019.1668541","article-title":"Spinal intradural arachnoid cyst as a complication of insertion of an interspinous device","volume":"36","author":"Lee","year":"2019","journal-title":"Br J Neurosurg."},{"key":"B30","doi-asserted-by":"publisher","first-page":"e97142","DOI":"10.1371\/journal.pone.0097142","article-title":"Interspinous spacer versus traditional decompressive surgery for lumbar spinal stenosis: a systematic review and meta-analysis","volume":"9","author":"Wu","year":"2014","journal-title":"PLoS ONE."},{"key":"B31","doi-asserted-by":"publisher","first-page":"153","DOI":"10.14444\/8020","article-title":"Comparison of adverse outcomes following placement of superion interspinous spacer device versus laminectomy and laminotomy","volume":"15","author":"Welton","year":"2021","journal-title":"Int J Spine Surg."},{"key":"B32","doi-asserted-by":"publisher","first-page":"E1080","DOI":"10.1097\/BRS.0b013e318204066a","article-title":"Occult spinous process fractures associated with interspinous process spacers","volume":"36","author":"Kim","year":"2011","journal-title":"Spine."},{"key":"B33","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1227\/01.NEU.0000346254.07116.31","article-title":"Analysis of complications in patients treated with the X-Stop Interspinous Process Decompression System: proposal for a novel anatomic scoring system for patient selection and review of the literature","volume":"65","author":"Barbagallo","year":"2009","journal-title":"Neurosurgery."},{"key":"B34","doi-asserted-by":"publisher","first-page":"7","DOI":"10.4103\/2152-7806.92172","article-title":"A review of interspinous fusion devices: high complication, reoperation rates, and costs with poor outcomes","volume":"3","author":"Epstein","year":"2012","journal-title":"Surg Neurol Int."},{"key":"B35","doi-asserted-by":"publisher","first-page":"865","DOI":"10.1097\/BRS.0b013e31828631b8","article-title":"Interspinous spacers compared with decompression or fusion for lumbar stenosis: complications and repeat operations in the Medicare population","volume":"38","author":"Deyo","year":"2013","journal-title":"Spine."},{"key":"B36","doi-asserted-by":"publisher","first-page":"E14","DOI":"10.3171\/2015.7.FOCUS15244","article-title":"Failure rates and complications of interspinous process decompression devices: a European multicenter study","volume":"39","author":"Gazzeri","year":"2015","journal-title":"Neurosurg Focus."},{"key":"B37","doi-asserted-by":"publisher","first-page":"E8","DOI":"10.3171\/2010.3.FOCUS1047","article-title":"Dynamic interspinous process stabilization: review of complications associated with the X-Stop device","volume":"28","author":"Bowers","year":"2010","journal-title":"Neurosurg Focus."},{"key":"B38","doi-asserted-by":"publisher","first-page":"2199","DOI":"10.1007\/s00264-013-2006-2","article-title":"Complications in degenerative lumbar disease treated with a dynamic interspinous spacer (Coflex)","volume":"37","author":"Xu","year":"2013","journal-title":"Int Orthop."}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2022.841134\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,16]],"date-time":"2022-03-16T04:40:46Z","timestamp":1647405646000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2022.841134\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,16]]},"references-count":38,"alternative-id":["10.3389\/fsurg.2022.841134"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2022.841134","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,16]]},"article-number":"841134"}}