coflex® Interlaminar Stabilization®
The coflex® Interlaminar Stabilization® device is a minimally invasive posterior lumbar motion preservation solution that addresses leg and back pain and has proven long-term outcomes for durable pain relief and stability.1
Decompression with interlaminar stabilization using the coflex device is performed through a small, midline incision in the lower back that allows for a minimally invasive approach for treating your lumbar spinal stenosis. The coflex device:
- Is inserted directly following a surgical decompression by your spine surgeon
- Rests on laminar bone in between two vertebrae, where the “U” is closest to the spinal canal
- Maintains foraminal height and off-loads facets
- Allows the bones to move in a controlled manner, preserving natural motion
- Reduces trauma to your back, decreases the amount of blood loss during surgery, and allows for a shorter hospital or outpatient surgical center stay compared to fusion
Benefits vs. Decompression2
Decompression is appropriate for many patients; however, in order for the surgeon to adequately decompress the spine, all bony and neural elements putting pressure on the spinal nerves causing the pain should be removed, which may cause the spine to become unstable. Your surgeon can implant the motion-preserving coflex device directly after a surgical decompression to help keep your spine stable.
In a European study, decompression with interlaminar stabilization using the coflex device was compared to decompression alone. The coflex device proved to extend the durability and sustainability of a decompression procedure out to two years. The coflex patients experienced:
- Superior composite clinical results (combination of 4 clinically relevant factors: disability improvement, neurological maintenance or improvement, no subsequent interventions, no device related complications) (P<0.05)
- Superior walking distance improvement (2.4x more compared to decompression alone) (P<0.05)
- Maintenance of foraminal height and disc height (allowing nerves to exit spinal canal freely)
- Significantly less epidural steroid injections post-surgery (decompression patients had 3.3x more) (P<0.05)
Clinical cases are unique and individual results may vary.
Benefits vs. Fusion3
Fusion is appropriate for many patients; however, motion is lost at both the treated and adjacent segments, multiple pieces of hardware and bone graft are required, and the recovery process can be long and difficult. Your surgeon can offer the coflex device as an alternative to fusion for moderate to severe lumbar spinal stenosis with <Grade I spondylolisthesis patients.
In a U.S. FDA study, decompression with interlaminar stabilization using the coflex device was compared to pedicle screw fusion. The coflex device proved to be a viable alternative treatment option compared to pedicle screw fusion out to 5 years, and results showed that coflex patients performed as good as if not better in all clinical measurements. The coflex patients experienced:
- Leg and back pain relief (both immediately and long-term)
- Less time in the operating room, less blood loss, and fewer days in the hospital
- Faster relief of symptoms and quicker recovery (pain and function measurements)
- Maintenance of range of motion at both treated and adjacent segments
Clinical cases are unique and individual results may vary.
Indications For Use
The coflex Interlaminar Technology is an interlaminar stabilization device indicated for use in one or two level lumbar stenosis from L1-L5 in skeletally mature patients with at least moderate impairment in function, who experience relief in flexion from their symptoms of leg/buttocks/groin pain, with or without back pain, and who have undergone at least 6 months of non-operative treatment. The coflex® is intended to be implanted midline between adjacent lamina of 1 or 2 contiguous lumbar motion segments. Interlaminar stabilization is performed after decompression of stenosis at the affected level(s).
The coflex® is contraindicated in patients with:
- Prior fusion or decompressive laminectomy at any index lumbar level.
- Radiographically compromised vertebral bodies at any lumbar level(s) caused by current or past trauma or tumor (e.g., compression fracture).
- Severe facet hypertrophy that requires extensive bone removal which would cause instability.
- Grade II or greater spondylolisthesis.
- Isthmic spondylolisthesis or spondylolysis (pars fracture).
- Degenerative lumbar scoliosis (Cobb angle of greater than 25º).
- Back or leg pain of unknown etiology.
- Axial back pain only, with no leg, buttock, or groin pain.
- Morbid obesity defined as a body mass index > 40.
- Active or chronic infection – systemic or local.
- Known allergy to titanium alloys or MR contrasting agents.
- Cauda equina syndrome defined as neural compression causing neurogenic bowel or bladder dysfunction.
Please see Instructions for Use for a complete list of Warnings and Precautions.
Important Considerations on Implant Usage
As a patient, there is always potential risk in having surgery or getting a medical device. Usually these risks are rare. You should refer to the coflex Patient Labeling for a list of all potential risks and hazards that were observed during the clinical study.4 For patients receiving coflex, the biggest risk is continued pain. Other risks include wound healing problems (such as infection or drainage), brief numbness or tingling in your arms or legs, and spinous process fractures. Some patients had illnesses or diseases not related to their surgery, like problems with their skin, problems breathing, problems with their heart, and other muscle or bone pain or soreness. In the clinical trial, similar problems were experienced with patients who had fusion. The coflex surgery may not help relieve pain in some patients, and you may need another surgery to remove the device. It is hard to predict who will not benefit from this surgery. Although uncommon, the device could be removed if necessary.
1 Musacchio, M. (2016). Evaluation of decompression and Interlaminar Stabilization compared with decompression and fusion for the treatment of lumbar spinal stenosis: 5 year follow-up of a prospective, randomized, controlled trial. International Journal of Spine Surgery.; Schmidt, S. (2018). Prospective, randomized, multicenter study with 2-year follow-up to compare the performance of decompression with and without interlaminar stabilization. Journal of Neurosurgery.
2 Schmidt, S. (2018). Prospective, randomized, multicenter study with 2-year follow-up to compare the performance of decompression with and without interlaminar stabilization. Journal of Neurosurgery.
3 Musacchio, M. (2016). Evaluation of decompression and Interlaminar Stabilization compared with decompression and fusion for the treatment of lumbar spinal stenosis: 5 year follow-up of a prospective, randomized, controlled trial. International Journal of Spine Surgery.
4 FDA PMA P110008, October 2012.