The renewed role of interspinous devices: the InSpan system—a narrative review on surgical indications

Introduction

Interspinous devices (ISDs) were first introduced more than two decades ago to provide a minimally invasive alternative for the management of lumbar spinal stenosis and neurogenic claudication by limiting spinal extension and indirectly enlarging the spinal canal and foramina to allow for decompression of neural elements (1). Early designs, including X-STOP, DIAM, Wallis, and Superion, initially demonstrated encouraging short-term improvements; however, long-term follow-up demonstrated high revision rates, implant migration, and spinous process fractures, which led to their gradual discontinuation (2-4).

More recent iterations of interspinous implants—including interspinous process fixation and interlaminar fixation systems—have been developed to provide indirect distraction while also adding posterior stabilization and facilitating fusion when combined with direct decompression (e.g., microscopic, endoscopic, or unilateral-approach bilateral decompression techniques). Within this broader category, the InSpan system is an interlaminar fixation construct that anchors against the lamina rather than acting solely as a spacer between spinous process tips (5).

The goal of this review is to define practical, evidence-based indications and contraindications for the InSpan system within the broader context of interspinous and interlaminar fixation, and to position this strategy among decompression alone, endoscopy, and pedicle-based fusion. We present this article in accordance with the Narrative Review reporting checklist (available at https://jss.amegroups.com/article/view/10.21037/jss-2025-1-232/rc).

Methods

This is a narrative review based on a targeted search of the PubMed/MEDLINE, Embase, and Cochrane Library databases up to November 2025 using combinations of the MeSH terms “interspinous device”, “interlaminar fixation”, “InSpan”, “lumbar spinal stenosis”, “spondylolisthesis”, and “disc herniation”. Additional references were identified from the bibliography of key articles and relevant device-specific publications. Priority was given to prospective studies, randomized controlled trials, biomechanical investigations, and series with at least 2-year follow-up. Because of the heterogeneity of study designs and outcomes, no formal meta-analysis was performed (Table 1, Table S1).

Evolution from spacers to interlaminar fixation

Early devices and limitations

The first generation of interspinous process devices emerged in the early 2000s with the goal of offering a minimally invasive surgical alternative for lumbar spinal stenosis and neurogenic claudication. Devices such as X-STOP, DIAM, Aperius, Superion, and Wallis were designed to distract the spinous processes and maintain the lumbar spine in relative flexion, thereby widening the spinal canal and foramen and indirectly reducing neural compression. Early multicenter trials demonstrated short-term clinical improvement, particularly in elderly who were poor candidates for fusion (1,4,6).

However, the enthusiasm surrounding these devices diminished as long-term data accumulated showing that several biomechanical weaknesses resulted in treatment failure or complications. The distraction-based mechanism primarily limited extension but offered minimal resistance to flexion, lateral bending, and rotational forces. Because these devices relied solely on the cortical integrity of the spinous processes, they were prone to spinous process fractures, bone osteolysis, device loosening and spinous process anastomosis, particularly in osteoporotic patients (4-6). Furthermore, without rigid fixation, many patients developed progressive instability or recurrent initial-level stenosis or adjacent segment disease, often requiring conversion to instrumented fusion (2,3). Revision rates exceeded 25–30% at 2 to 5 years, significantly higher than decompression alone, attributed to inadequate fusion and resulting instability of the involved levels (3,5,7). Histological and radiographic analyses and imaging studies also revealed fibrous encapsulation rather than true osseous fusion around early devices, which explained the high incidence of recurrent symptoms and persistent back pain (6). Consequently, many first-generation devices were withdrawn from the market, and surgeons largely abandoned interspinous implants in favor of conventional decompression or minimally invasive transpedicular fixation. The lessons learned from this first era highlighted that distractive decompression alone was often insufficient, and that durable outcomes likely depend on adequate segmental stability and, when intended, successful biologic fusion of the treated level.

The InSpan system: design and evidence

Device characteristics

The InSpan system (InSpan LLC, Burlington, MA 01803, USA) is classified as a posterior, non-pedicle interlaminar fixation device. It is implanted directly against the lamina with plates that capture and couple the spinous processes, and it can serve as a scaffold for bone graft placement to facilitate posterior fusion between adjacent laminae and spinous processes (8,9). Its design aims to improve flexion-extension stability and may help maintain foraminal height and share load after decompression (10). Compared with earlier distraction-only ISDs, features such as laminar contact and locking screws are intended to reduce the risk of migration or loosening and to distribute forces across posterior elements rather than concentrating loads at the spinous process tips (9,11). If reoperation is required, the construct can be removed by reversing the locking mechanism.

Clinical outcomes and evidence

Published clinical series have reported mid- to long-term outcomes with InSpan used as a posterior fixation adjunct to decompression. Chin et al. [2020] evaluated 122 patients undergoing decompression with single-level (L4–L5) InSpan fixation, reporting mean operative time <60 minutes, discharge within 24 hours, and improvements in Visual Analog Scale (VAS) (from 8.1 to 1.5) and Oswestry Disability Index (ODI) (from 42.9 to 14.8) at 5 years; one reoperation was reported during follow-up (9). When applied to other spinal levels, Chin et al. [2023] published a 5-year follow-up of 100 patients at L4–L5 and L5–S1 showing sustained improvements in pain and disability, with revision rates <5%, none of which were attributed to implant failure (10). Raikar et al. also published a case series with results that support the use of ISDs such as InSpan in the treatment of disc herniations, reducing pain as measured by validated scales (12). Biomechanical studies have reported increased flexion-extension stiffness compared with spacer-type ISDs and improved load transfer when combined with bone graft placed in the device hub (13,14). No warnings or recall notifications are reported in the referenced Food and Drug Administration (FDA) 510(k) summary for the device (15).

Evidence-based surgical indications and patient selection

Drawing from the limitations reported with early distraction-only ISDs and from available data on interspinous/interlaminar fixation systems, the literature supports a set of potential indications in carefully selected patients. InSpan and similar fixation systems are generally described as adjuncts to direct decompression of the neural elements. Based on published studies and expert opinion, commonly proposed indications include:

Recurrent disc herniation after previous microdiscectomy with mild segmental instability or micromotion

Lumbar disc herniation and its surgical treatment inherently alter spinal biomechanics and may predispose to segmental instability. As reported in the literature, following discectomy, reherniation rates may be as high as 27%, reoperation rates up to 21%, and persistent symptoms up to 38%, depending on the degree of annular defect (16). The main risk factors for recurrent disc herniation—large annular defects and limited disc removal at the index surgery—both accelerate disc-height loss, a problem that can be mitigated by the InSpan system (13,14,17).

The benefits of combining an ISD with microdiscectomy—whether performed through open or endoscopic approaches—have been documented in the literature. In a prospective cohort study of 383 patients, the addition of an interspinous system resulted in hospital length of stay, complication rates, and VAS and ODI scores that were comparable to those of standalone discectomy, while achieving greater average disc height and a lower rate of reoperation due to instability compared with open or endoscopic discectomy alone (18). Other studies have supported these findings, reporting reduced pain medication use, faster return to work, and higher overall patient satisfaction in ISD-treated cohorts (19). Additional series comparing ISDs with posterior lumbar interbody fusion (PLIF) with pedicle screws in the setting of lumbar disc herniation have shown shorter hospital stays and lower in-hospital costs with ISDs, with no significant differences in complication, readmission, or reoperation rates (20).

Interlaminar fixation may be considered in selected patients undergoing microdiscectomy—whether traditional, tubular, or endoscopic—when there is concern for postoperative micromotion, recurrent symptoms, or progressive loss of disc height. Although these procedures are effective for symptom relief, they do not restore stability after partial removal of the intervertebral disc and are associated with progressive loss of disc height, a problem that is further accentuated in the setting of recurrent herniation (21). In this context, a posterior fixation strategy intended to promote osseous fusion (including ISDs such as InSpan) has been reported as one approach to address segmental instability-related pain and well as minimizing recurrent herniation risks in appropriately selected patients (6,8,9).

Single-level lumbar spinal stenosis at L4–L5 or L5–S1 with low-grade (Grade I) spondylolisthesis or minor instability, particularly in geriatric or high-risk patients who are unfit for full fusion

Pedicle screw fixation has long been the standard method for achieving lumbar stability and fusion. Nevertheless, in elderly patients with degenerative disease its efficacy is challenged by reduced bone mineral density, lower fusion rates, and higher complication profiles, with reported rates of screw loosening ranging from 10% to 60% and osteoporosis figures approaching the upper limit in single-level degenerative cases (22-24). Even when radiographic fusion is achieved, many patients continue to experience persistent low back pain, attributed to muscle denervation, scarring, and altered biomechanics of adjacent segments.

In contrast, interlaminar fixation devices such as InSpan can provide posterior stabilization without the need for pedicle instrumentation. By anchoring to the spinous processes and laminae, they may reduce the extent of muscle dissection and preserve posterior elements, with potential reductions in blood loss and operative time (9,10,14,25,26). Studies have demonstrated that, although interlaminar fusion does not match the rotational rigidity of pedicle screws, it provides flexion-extension control that may be sufficient to facilitate interlaminar fusion in single-level degenerative pathology, with symptom relief comparable to PLIF as measured by VAS and ODI scores in appropriately selected patients, providing added benefits such as of shorter operative times, less estimated blood loss and less perioperative complications (22,27,28). Other reported benefits of an ISD strategy include comparable osseous fusion and a narrower increase in mobility of adjacent segments when compared with PLIF, which may translate to reduced rates of adjacent segment disease and reoperation (28).

Clinically, InSpan has been shown to achieve pain relief and functional improvement comparable to single-level pedicle screw fusion, with fewer perioperative complications, particularly in older adults (9,10,22). Studies analyzing fusion rates with ISDs have shown osseous fusion in 84% to 87% of patients undergoing single-level decompressive surgery with an interspinous implant, often including fusion across the facet joints, with only 0.7–5.4% demonstrating increased postoperative spinal instability (29,30). Furthermore, a meta-analysis on ISD use for degenerative lumbar disease that included six randomized controlled trials found that, compared with decompression alone, decompression plus an ISD resulted in better VAS back and leg pain scores as well, improved overall functional status and less reported treatment failures, further supporting the stabilizing role of these devices (31).

Recognizing the limitations of systems such as InSpan is equally important for appropriate patient selection and optimal outcomes. Candidates not suited for an ISD include those with instability greater than Grade II or >3 mm translation/>10° angulation, as well as patients with severe facet arthropathy, deformity, or osteoporosis with thin spinous processes (22,32). Caution is also warranted at L5–S1, where spinous morphology and biomechanical load increase risk of implant loosening (25,33).

Extreme lateral or foraminal herniations requiring decompression with preservation of foraminal height

Foraminal stenosis produces neurogenic pain in the affected nerve root, and surgical decompression has long been considered the gold-standard treatment. Beyond direct neural decompression, foraminal height itself has been recognized as an important determinant of symptom relief (1). The effect of ISDs on foraminal dimensions has been documented in multiple studies, which consistently show that implantation of an ISD increases foraminal area, height, and width without adversely affecting foraminal dimensions at adjacent levels (34). These biomechanical changes have been shown to persist in the upright position during both flexion and extension (35). In cases of isolated foraminal stenosis, ISDs have demonstrated promising clinical results, with reductions in VAS pain scores, improvements in ODI disability indices, and better SF-36 health-related quality-of-life scores (36).

In recent years, endoscopic lumbar decompression has revolutionized the management of spinal stenosis and herniated discs by providing direct neural decompression through tubular or full-endoscopic approaches. These techniques minimize muscle trauma, reduce hospital stay, and allow faster recovery compared with open surgery (37). For purely compressive pathologies without radiographic or clinical instability, endoscopy alone remains the gold standard because of its minimal invasiveness and excellent visualization (38).

However, in the context of foraminal stenosis, an interlaminar fixation adjunct may be considered when decompression requires partial facet resection or when there is concern for postoperative micromotion and progressive foraminal collapse. Following decompression—particularly when facet joint resection is required—dynamic loading may lead to micromotion, loss of foraminal height, or recurrent radicular pain, issues that decompression alone (open or endoscopic) may not address when instability is present. When used after decompression, an ISD/interlaminar fixation system such as InSpan can provide segmental stabilization and may help maintain foraminal height without the morbidity associated with pedicle screw instrumentation (9,10,25). In this setting, decompression and interlaminar fixation can be viewed as complementary components across the minimally invasive treatment spectrum rather than competing strategies.

Technical considerations and surgical pearls

Based on the surgical techniques employed in studies that have led to promising results, technical consideration that might yield good surgical outcomes can be identified. Direct decompression (laminectomy, flavectomy, or foraminotomy) should always be performed before implant insertion, and the implant size must be selected to restore foraminal height without causing over-distraction (9). Use at L5–S1 should be avoided unless the S1 spinous process is robust, and the device should not be employed in multilevel disease or in the presence of gross instability (9,10). Placement of bone graft material between the laminae may enhance fusion success, and early postoperative mobilization is encouraged.

Discussion

The evolution of interspinous process technology mirrors the ongoing search for less invasive yet biomechanically stable options for lumbar degenerative disease. The early generation of distraction-type devices, such as the X-STOP and DIAM, aimed primarily to reduce lumbar extension and enlarge the spinal canal indirectly. While initial outcomes were satisfactory, the lack of rigid fixation and the reliance solely on posterior element integrity often resulted in micromotion, subsidence, or device migration, leading to loss of correction and high revision rates (2-4,6-8). The ensuing skepticism caused many surgeons to abandon these devices and return to traditional decompression or fusion procedures. Recently, interspinous fixation and fusion techniques have been utilized for many years in conjunction with direct decompression, including microscopic, endoscopic, unilateral-approach and bilateral decompression strategies, using multiple devices with interspinous and interlaminar constructs. In this context, interlaminar fixation systems represent an evolution of established posterior fixation concepts rather than a new principle. Instead of serving merely as a spacer, the InSpan device acts as a posterior stabilization and fusion platform positioned flush against the lamina, which allows for the placement of bone graft material to support biological fusion (9,10,14,25,39,40). These design refinements may improve mechanical stability and broaden the potential clinical indications for selected patients. Biomechanical testing has demonstrated increased stiffness in flexion-extension and comparable stiffness in lateral bending relative to dynamic interspinous spacers (10,39). Although its rotational stability remains lower than that achieved with pedicle screw constructs, the balance between stabilization and a less extensive posterior approach may make it an option for cases of mild instability or revision after prior discectomy. Clinically, prospective series have reported durable results at up to 5 years with low reoperation rates when used after appropriate decompression (9,10,25). Nevertheless, the evidence base is still limited. Most available studies are single-center or retrospective with relatively small cohorts, and there are no large randomized controlled trials directly comparing InSpan with pedicle screw fixation or minimally invasive decompression alone. Additionally, cost-effectiveness analyses and long-term evaluations beyond 5 years are lacking. Therefore, while reported outcomes are encouraging, adoption should remain cautious and data driven.

From a practical standpoint, InSpan may occupy a therapeutic niche for selected patients by providing posterior stabilization without pedicle-based instrumentation. This option may be relevant for elderly or medically fragile patients, those with low-grade spondylolisthesis, or recurrent disc herniation after prior decompression. It may also be considered in cases of foraminal or extraforaminal pathology where maintaining foraminal height is important to reduce the risk of recurrent nerve root compression. However, in patients with gross instability (Grade II or higher), deformity, or multi-level disease, pedicle screw fixation remains the gold standard (22,33). When compared with endoscopic decompression, interlaminar fixation should be viewed as complementary rather than competitive: endoscopic or minimally invasive decompression addresses neural compression, whereas fixation may be considered when there is concern for postoperative motion or collapse. Both modalities can therefore coexist within a minimally invasive algorithm—decompression alone for purely compressive disease and decompression plus interlaminar fixation for selected cases where stabilization is desired (9,10,14,25).

Future research should focus on multicenter randomized comparisons between InSpan-assisted fusion, minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF), and endoscopic decompression alone. Such studies would clarify the cost-benefit ratio, ideal indications, and long-term radiological fusion rates. Additionally, biomechanical studies investigating hybrid constructs that combine interlaminar fixation with cortical screw or facet stabilization could further refine surgical strategies for early degenerative instability.

Conclusions

Interlaminar fixation devices such as InSpan may fill a therapeutic niche between decompression alone and pedicle-screw fusion for carefully selected patients with degenerative lumbar disease. Available biomechanical and clinical data suggest that, when combined with adequate decompression, InSpan can provide flexion-extension stability, promote interlaminar fusion, and improve pain and disability with lower surgical morbidity in single-level pathology. The most suitable candidates are patients with recurrent disc herniation, low-grade spondylolisthesis or minor instability, and foraminal or far-lateral stenosis in whom preservation or restoration of foraminal height is important and pedicle-based constructs are undesirable or high risk. In contrast, severe instability, deformity, and multilevel disease remain better treated with conventional fusion. Further prospective, comparative, and long-term studies are required to refine patient selection, confirm durability of outcomes, and clarify cost-effectiveness of interlaminar fixation strategies.

Acknowledgments

The authors would like to acknowledge the support provided by Dr. Kingsley Chin from The LESS Institute Outpatient Center of Excellence, who provided technical input for the “Surgical Pearls” section and guidance on published outcomes literature relevant to interspinous and interlaminar fixation systems (including InSpan).

Footnote

Reporting Checklist: The authors have completed the Narrative Review reporting checklist. Available at https://jss.amegroups.com/article/view/10.21037/jss-2025-1-232/rc

Peer Review File: Available at https://jss.amegroups.com/article/view/10.21037/jss-2025-1-232/prf

Funding: None.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jss.amegroups.com/article/view/10.21037/jss-2025-1-232/coif). The authors have no conflicts of interest to declare

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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References

1. Zucherman JF, Hsu KY, Hartjen CA, et al. A prospective randomized multi-center study for the treatment of lumbar spinal stenosis with the X STOP interspinous implant: 1-year results. Eur Spine J 2004;13:22-31. [Crossref] [PubMed]
2. Siddiqui M, Smith FW, Wardlaw D. One-year results of X Stop interspinous implant for the treatment of lumbar spinal stenosis. Spine (Phila Pa 1976) 2007;32:1345-8. [Crossref] [PubMed]
3. Bowers C, Amini A, Dailey AT, et al. Dynamic interspinous process stabilization: review of complications associated with the X-Stop device. Neurosurg Focus 2010;28:E8. [Crossref] [PubMed]
4. Moojen WA, Arts MP, Jacobs WC, et al. Interspinous process device versus standard conventional surgical decompression for lumbar spinal stenosis: randomized controlled trial. BMJ 2013;347:f6415. [Crossref] [PubMed]
5. Verhoof OJ, Bron JL, Wapstra FH, et al. High failure rate of the interspinous distraction device (X-Stop) for the treatment of lumbar spinal stenosis caused by degenerative spondylolisthesis. Eur Spine J 2008;17:188-92. [Crossref] [PubMed]
6. Li KY, Li HL, Chen LJ, et al. Complications and radiographic changes after implantation of interspinous process devices: average eight-year follow-up. BMC Musculoskelet Disord 2023;24:667. [Crossref] [PubMed]
7. Davis RJ, Errico TJ, Bae H, et al. Decompression and Coflex interlaminar stabilization compared with decompression and instrumented spinal fusion for spinal stenosis and low-grade degenerative spondylolisthesis: two-year results from the prospective, randomized, multicenter, Food and Drug Administration Investigational Device Exemption trial. Spine (Phila Pa 1976) 2013;38:1529-39. [Crossref] [PubMed]
8. InSpan LLC. InSpan Interlaminar Fixation Device: Surgical Technique Guide. Mansfield (MA): InSpan LLC; 2018.
9. Chin KR, Pencle FJR, Benny A, et al. Greater than 5-year follow-up of outpatient L4-L5 lumbar interspinous fixation for degenerative spinal stenosis using the INSPAN device. J Spine Surg 2020;6:549-54. [Crossref] [PubMed]
10. Chin KR, Seale JA, Spayde E, et al. Prospective 5-year follow-up of L5-S1 versus L4-5 midline decompression and interspinous-interlaminar fixation as a stand-alone treatment for spinal stenosis compared with laminectomies. J Spine Surg 2023;9:398-408. [Crossref] [PubMed]
11. Chin KR, Lore V, Spayde E, et al. Advancing the design of interspinous fixation devices for improved biomechanical performance: dual vs. single-locking set screw mechanisms and symmetrical vs. asymmetrical plate designs. J Spine Surg 2024;10:386-94. [Crossref] [PubMed]
12. Raikar SV, Patil AA, Pandey DK, et al. Inter Spinal Fixation and Stabilization Device for Lumbar Radiculopathy and Back Pain. Cureus 2021;13:e19956. [Crossref] [PubMed]
13. Chen M, Deng J, Bao L, et al. Biomechanical characteristics of a novel interspinous distraction fusion device in the treatment of lumbar degenerative diseases: a finite element analysis. BMC Musculoskelet Disord 2023;24:944. [Crossref] [PubMed]
14. Liu Z, Zhang S, Li J, et al. Biomechanical comparison of different interspinous process devices in the treatment of lumbar spinal stenosis: a finite element analysis. BMC Musculoskelet Disord 2022;23:585. [Crossref] [PubMed]
15. U.S. Food and Drug Administration. 510(k) summary: InSpan Spinous Process Fixation System. Silver Spring (MD): U.S. Food and Drug Administration; 2015.
16. Carragee EJ, Han MY, Suen PW, et al. Clinical outcomes after lumbar discectomy for sciatica: the effects of fragment type and anular competence. J Bone Joint Surg Am 2003;85:102-8.
17. McGirt MJ, Eustacchio S, Varga P, et al. A prospective cohort study of close interval computed tomography and magnetic resonance imaging after primary lumbar discectomy: factors associated with recurrent disc herniation and disc height loss. Spine (Phila Pa 1976) 2009;34:2044-51. [Crossref] [PubMed]
18. Lee CC, Lin RM, Juan WS, et al. Comparing Clinical Outcomes of Microdiscectomy, Interspinous Device Implantation, and Full-Endoscopic Discectomy for Simple Lumbar Disc Herniation. J Clin Med 2025;14:1925. [Crossref] [PubMed]
19. Plasencia Arriba MÁ, Maestre C, Martín-Gorroño F, et al. Analysis of Long-Term Results of Lumbar Discectomy With and Without an Interspinous Device. Int J Spine Surg 2022;16:681-9. [Crossref]
20. Segura-Trepichio M, Candela-Zaplana D, Montoza-Nuñez JM, et al. Length of stay, costs, and complications in lumbar disc herniation surgery by standard PLIF versus a new dynamic interspinous stabilization technique. Patient Saf Surg 2017;11:26. [Crossref] [PubMed]
21. Schaller B. Failed back surgery syndrome: the role of symptomatic segmental single-level instability after lumbar microdiscectomy. Eur Spine J 2004;13:193-8. [Crossref] [PubMed]
22. Orlando V, Galieri G, Mazzucchi E, et al. Comparative Analysis of Pedicle Screw Fixation and Interspinous Devices in Lumbar Spinal Fusion: Clinical and Surgical Outcomes in Degenerative Spine Conditions. J Pers Med 2025;15:95. [Crossref] [PubMed]
23. Wagener C, Gandhi A, Ferry C, et al. Biomechanical Analysis of an Interspinous Process Fixation Device with In Situ Shortening Capabilities: Does Spinous Process Compression Improve Segmental Stability? World Neurosurg 2020;144:e483-94. [Crossref] [PubMed]
24. Tsagkaris C, Calek AK, Fasser MR, et al. Bone density optimized pedicle screw insertion. Front Bioeng Biotechnol 2023;11:1270522. [Crossref] [PubMed]
25. Gazzeri R, Galarza M, Alfieri A. Controversies about interspinous process devices in the treatment of degenerative lumbar spine diseases: past, present, and future. Biomed Res Int 2014;2014:975052. [Crossref] [PubMed]
26. Epstein NE, Agulnick MA. Perspective: Efficacy and outcomes for different lumbar interspinous devices (ISD) vs. open surgery to treat lumbar spinal stenosis (LSS). Surg Neurol Int 2024;15:17. [Crossref] [PubMed]
27. Jung SC, Jung JH, Hong JH, et al. The efficacy and safety of decompression with interspinous fixation for lumbar spondylolisthesis when compared with posterior lumbar interbody fusion: A pilot study. Medicine (Baltimore) 2024;103:e38501. [Crossref] [PubMed]
28. Yuan W, Su QJ, Liu T, et al. Evaluation of Coflex interspinous stabilization following decompression compared with decompression and posterior lumbar interbody fusion for the treatment of lumbar degenerative disease: A minimum 5-year follow-up study. J Clin Neurosci 2017;35:24-9. [Crossref] [PubMed]
29. Postacchini F, Postacchini R, Menchetti PP, et al. Lumbar Interspinous Process Fixation and Fusion with Stand-Alone Interlaminar Lumbar Instrumented Fusion Implant in Patients with Degenerative Spondylolisthesis Undergoing Decompression for Spinal Stenosis. Asian Spine J 2016;10:27-37. [Crossref] [PubMed]
30. Lee DY, Lee SH, Shim CS, et al. Decompression and interspinous dynamic stabilization using the locker for lumbar canal stenosis associated with low-grade degenerative spondylolisthesis. Minim Invasive Neurosurg 2010;53:117-21. [Crossref] [PubMed]
31. Poetscher AW, Gentil AF, Ferretti M, et al. Interspinous process devices for treatment of degenerative lumbar spine stenosis: A systematic review and meta-analysis. PLoS One 2018;13:e0199623. [Crossref] [PubMed]
32. Kim DH, Shanti N, Tantorski ME, et al. Association between degenerative spondylolisthesis and spinous process fracture after interspinous process spacer surgery. Spine J 2012;12:466-72. [Crossref] [PubMed]
33. Gazzeri R, Galarza M, Neroni M, et al. Failure rates and complications of interspinous process decompression devices: a European multicenter study. Neurosurg Focus 2015;39:E14. [Crossref] [PubMed]
34. Wan Z, Wang S, Kozanek M, et al. The effect of the X-Stop implantation on intervertebral foramen, segmental spinal canal length and disc space in elderly patients with lumbar spinal stenosis. Eur Spine J 2012;21:400-10. [Crossref] [PubMed]
35. Siddiqui M, Karadimas E, Nicol M, et al. Influence of X Stop on neural foramina and spinal canal area in spinal stenosis. Spine (Phila Pa 1976) 2006;31:2958-62. [Crossref] [PubMed]
36. Hobart J, Gilkes C, Adams W, et al. Interspinous spacers for lumbar foraminal stenosis: formal trials are justified. Eur Spine J 2013;22:S47-53. [Crossref] [PubMed]
37. Cinotti G, De Santis P, Nofroni I, et al. Stenosis of lumbar intervertebral foramen: anatomic study on predisposing factors. Spine (Phila Pa 1976) 2002;27:223-9. [Crossref] [PubMed]
38. Ahn Y. Percutaneous endoscopic decompression for lumbar spinal stenosis. Expert Rev Med Devices 2014;11:605-16. [Crossref] [PubMed]
39. Yang F, Ren L, Ye Q, et al. Endoscopic and Microscopic Interlaminar Discectomy for the Treatment of Far-Migrated Lumbar Disc Herniation: A Retrospective Study with a 24-Month Follow-Up. J Pain Res 2021;14:1593-600. [Crossref] [PubMed]
40. Schlegel JD, Champine J, Taylor MS, et al. The role of distraction in improving the space available in the lumbar stenotic canal and foramen. Spine (Phila Pa 1976) 1994;19:2041-7. [Crossref] [PubMed]