Vertiflex works great. Most are very aged because this procedure is limited to traditional Medicare here. I have done around 250. I am pretty confident less than 10% have been explanted or revised. I have only revised a couple to a fusion spacer. I removed one a couple days after placing as I placed a 16mm and caused a radiculopathy from an adjacent nerve.
Spinous process fracture is fairly asymptomatic and doesn’t typically require removal of the device or any intervention.
Have I seen some of them a little wonky when I go back and do a RFA? Sure. But that is expected. They aren’t secured with anything other than the vertebral columns own spring pressure and the pressure of the surrounding tissue/surgical scarring. If they are still between the spinous processes, even a little rotated, they are still limiting extension at that segment and thus doing their job. I place mostly 12mm spacers, quite a few 14mm, and rarely 10mm. I don’t use the sizer. I use my eyeballs and the objective knowledge of how big the rasp and final dilator are.
I am pretty confident that my most satisfied patients have been vertiflex patients and they continue to spread good word of mouth. It is such a tiny wack and very well tolerated. It doesn’t make anyone worse and doesn’t cause any adjacent segment disease or same level listhesis.