Limits...
Short term outcome of posterior dynamic stabilization system in degenerative lumbar diseases.

Yang M, Li C, Chen Z, Bai Y, Li M - Indian J Orthop (2014)

Bottom Line: For range of motion (ROM) of operated level, significant decrease was found in both groups (P < 0.001), but Dynesys showed a higher preservation of motion at the operative levels (P < 0.001).However, no significant difference was found in the percentage change of ROM of adjacent levels between Dynesys and PLIF (0.74 ± 8.92% vs. 0.92 ± 4.52%, P = 0.91).Dynamic stabilization system treating lumbar degenerative disease showed clinical benefits with motion preservation of the operated segments, but does not have the significant advantage on motion preservation at adjacent segments, to avoid the degeneration of adjacent intervertebral disk.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, Changhai Hospital, Shanghai, China.

ABSTRACT

Background: Decompression and fusion is considered as the 'gold standard' for the treatment of degenerative lumbar diseases, however, many disadvantages have been reported in several studies, recently like donor site pain, pseudoarthrosis, nonunion, screw loosening, instrumentation failure, infection, adjacent segment disease (ASDis) and degeneration. Dynamic neutralization system (Dynesys) avoids many of these disadvantages. This system is made up of pedicle screws, polyethylene terephthalate cords, and polycarbonate urethane spacers to stabilize the functional spinal unit and preserve the adjacent motion after surgeries. This was a retrospective cohort study to compare the effect of Dynesys for treating degenerative lumbar diseases with posterior lumbar interbody fusion (PLIF) based on short term followup.

Materials and methods: Seventy five consecutive patients of lumbar degenerative disease operated between October 2010 and November 2012 were studied with a minimum followup of 2 years. Patients were divided into two groups according to the different surgeries. 30 patients underwent decompression and implantation of Dynesys in two levels (n = 29) or three levels (n = 1) and 45 patients underwent PLIF in two levels (n = 39) or three levels (n = 6). Clinical and radiographic outcomes between two groups were reviewed.

Results: Thirty patients (male:17, female:13) with a mean age of 55.96 ± 7.68 years were included in Dynesys group and the PLIF group included 45 patients (male:21, female:24) with a mean age of 54.69 ± 3.26 years. The average followup in Dynesys group and PLIF group was 2.22 ± 0.43 year (range 2-3.5 year) and 2.17 ± 0.76 year (range 2-3 year), respectively. Dynesys group showed a shorter operation time (141.06 ± 11.36 min vs. 176.98 ± 6.72 min, P < 0.001) and less intraoperative blood loss (386.76 ± 19.44 ml vs. 430.11 ± 24.72 ml, P < 0.001). For Dynesys group, visual analogue scale (VAS) for back and leg pain improved from 6.87 ± 0.80 to 2.92 ± 0.18 and 6.99 ± 0.81 to 3.25 ± 0.37, (both P < 0.001) and for PLIF, VAS for back and leg pain also improved significantly (6.97 ± 0.84-3.19 ± 0.19 and 7.26 ± 0.76-3.56 ± 0.38, both P < 0.001). Significant improvement was found at final followup in both groups in Oswestry disability index (ODI) score (both P < 0.001). Besides, Dynesys group showed a greater improvement in ODI and VAS back and leg pain scores compared with the PLIF group (P < 0.001, P = 0.009 and P = 0.031, respectively). For radiological, height of the operated level was found increased in both groups (both P < 0.001), but there was no difference between two groups (P = 0.93). For range of motion (ROM) of operated level, significant decrease was found in both groups (P < 0.001), but Dynesys showed a higher preservation of motion at the operative levels (P < 0.001). However, no significant difference was found in the percentage change of ROM of adjacent levels between Dynesys and PLIF (0.74 ± 8.92% vs. 0.92 ± 4.52%, P = 0.91). Some patients suffered from degeneration of adjacent intervertebral disc at final followup, but there was no significant difference in adjacent intervertebral disc degeneration between two groups (P = 0.71). Moreover, there were no differences in complications between Dynesys and PLIF (P = 0.90), although the incidence of complication in Dynesys was lower than PLIF (16.67% vs. 17.78%).

Conclusion: Dynamic stabilization system treating lumbar degenerative disease showed clinical benefits with motion preservation of the operated segments, but does not have the significant advantage on motion preservation at adjacent segments, to avoid the degeneration of adjacent intervertebral disk.

No MeSH data available.


Related in: MedlinePlus

Preoperative radiographs anteroposterior (a) and lateral (b) views of a 60-year-old male with disc herniation in L3-L4 and L4-L5 showing degenerative changes in lumbosacral area (c) Preoperative magnetic resonance imaging (MRI) T2W sagittal cut showing the disc herniation in L3-L4 and L4-L5. (d) Preoperative MRI T2W axial image showing Grade II degeneration of the disc in L3-L4. (e and f) Postoperative radiographs with dynamic neutralization system. (g) Postoperative MRI image showing no significant degenerative changes in intervertebral disc
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4232826&req=5

Figure 1: Preoperative radiographs anteroposterior (a) and lateral (b) views of a 60-year-old male with disc herniation in L3-L4 and L4-L5 showing degenerative changes in lumbosacral area (c) Preoperative magnetic resonance imaging (MRI) T2W sagittal cut showing the disc herniation in L3-L4 and L4-L5. (d) Preoperative MRI T2W axial image showing Grade II degeneration of the disc in L3-L4. (e and f) Postoperative radiographs with dynamic neutralization system. (g) Postoperative MRI image showing no significant degenerative changes in intervertebral disc

Mentions: Height of the operated level was significantly increased in both two groups at final followup compared with the preoperative disc height [Dynesys group: Table 3, PILF group: Table 4, both, P < 0.001], but the difference of percentage change of operated level height was not significant between two groups [Table 5, P = 0.93]. Significant decrease of ROM at the operated level at final followup was also observed in both groups [Dynesys group: Table 3, PILF group: Table 4, both, P < 0.001], but ROM of the operated level in Dynesys group was greater than that in PLIF group (2.97 ± 0.12° vs. 1.25 ± 0.16°) and the percentage change at final followup was also significant (−63.56 ± 4.66% vs.−84.42 ± 2.92%, P < 0.001). The ROM of adjacent segment did not increase significantly in both Dynesys (from 8.15 ± 0.79° to 8.22 ± 0.25°, P = 0.58) and PLIF group (from 8.39 ± 0.78° to 8.44 ± 0.59°, P = 0.32) and there was no significant difference in percentage change of the adjacent segment's ROM between two groups (0.74 ± 8.92 vs. 0.92 ± 4.52, P = 0.91). According to preoperative MRI, in Dynesys group, 17 patients had Grade II degeneration, another 12 Grade III and 1 Grade IV and in PLIF group, 22 patients had Grade II degeneration, another 20 Grade III and 3 Grade IV. At final followup, in Dynesys group, 12 patients had Grade II, 15 patients Grade III and 3 patients Grade IV and in PLIF group, 20 patients had Grade II degeneration, another 21 Grade III, 4 had Grade IV. Although some patients in both groups underwent the degeneration of adjacent intervertebral disc, the difference between preoperative MRI and followup both groups was not significant [Tables 3 and 4]. In addition, the difference of disc degeneration at final followup between two groups was also not significant [Table 5, P = 0.71] [Figure 1].


Short term outcome of posterior dynamic stabilization system in degenerative lumbar diseases.

Yang M, Li C, Chen Z, Bai Y, Li M - Indian J Orthop (2014)

Preoperative radiographs anteroposterior (a) and lateral (b) views of a 60-year-old male with disc herniation in L3-L4 and L4-L5 showing degenerative changes in lumbosacral area (c) Preoperative magnetic resonance imaging (MRI) T2W sagittal cut showing the disc herniation in L3-L4 and L4-L5. (d) Preoperative MRI T2W axial image showing Grade II degeneration of the disc in L3-L4. (e and f) Postoperative radiographs with dynamic neutralization system. (g) Postoperative MRI image showing no significant degenerative changes in intervertebral disc
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4232826&req=5

Figure 1: Preoperative radiographs anteroposterior (a) and lateral (b) views of a 60-year-old male with disc herniation in L3-L4 and L4-L5 showing degenerative changes in lumbosacral area (c) Preoperative magnetic resonance imaging (MRI) T2W sagittal cut showing the disc herniation in L3-L4 and L4-L5. (d) Preoperative MRI T2W axial image showing Grade II degeneration of the disc in L3-L4. (e and f) Postoperative radiographs with dynamic neutralization system. (g) Postoperative MRI image showing no significant degenerative changes in intervertebral disc
Mentions: Height of the operated level was significantly increased in both two groups at final followup compared with the preoperative disc height [Dynesys group: Table 3, PILF group: Table 4, both, P < 0.001], but the difference of percentage change of operated level height was not significant between two groups [Table 5, P = 0.93]. Significant decrease of ROM at the operated level at final followup was also observed in both groups [Dynesys group: Table 3, PILF group: Table 4, both, P < 0.001], but ROM of the operated level in Dynesys group was greater than that in PLIF group (2.97 ± 0.12° vs. 1.25 ± 0.16°) and the percentage change at final followup was also significant (−63.56 ± 4.66% vs.−84.42 ± 2.92%, P < 0.001). The ROM of adjacent segment did not increase significantly in both Dynesys (from 8.15 ± 0.79° to 8.22 ± 0.25°, P = 0.58) and PLIF group (from 8.39 ± 0.78° to 8.44 ± 0.59°, P = 0.32) and there was no significant difference in percentage change of the adjacent segment's ROM between two groups (0.74 ± 8.92 vs. 0.92 ± 4.52, P = 0.91). According to preoperative MRI, in Dynesys group, 17 patients had Grade II degeneration, another 12 Grade III and 1 Grade IV and in PLIF group, 22 patients had Grade II degeneration, another 20 Grade III and 3 Grade IV. At final followup, in Dynesys group, 12 patients had Grade II, 15 patients Grade III and 3 patients Grade IV and in PLIF group, 20 patients had Grade II degeneration, another 21 Grade III, 4 had Grade IV. Although some patients in both groups underwent the degeneration of adjacent intervertebral disc, the difference between preoperative MRI and followup both groups was not significant [Tables 3 and 4]. In addition, the difference of disc degeneration at final followup between two groups was also not significant [Table 5, P = 0.71] [Figure 1].

Bottom Line: For range of motion (ROM) of operated level, significant decrease was found in both groups (P < 0.001), but Dynesys showed a higher preservation of motion at the operative levels (P < 0.001).However, no significant difference was found in the percentage change of ROM of adjacent levels between Dynesys and PLIF (0.74 ± 8.92% vs. 0.92 ± 4.52%, P = 0.91).Dynamic stabilization system treating lumbar degenerative disease showed clinical benefits with motion preservation of the operated segments, but does not have the significant advantage on motion preservation at adjacent segments, to avoid the degeneration of adjacent intervertebral disk.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics, Changhai Hospital, Shanghai, China.

ABSTRACT

Background: Decompression and fusion is considered as the 'gold standard' for the treatment of degenerative lumbar diseases, however, many disadvantages have been reported in several studies, recently like donor site pain, pseudoarthrosis, nonunion, screw loosening, instrumentation failure, infection, adjacent segment disease (ASDis) and degeneration. Dynamic neutralization system (Dynesys) avoids many of these disadvantages. This system is made up of pedicle screws, polyethylene terephthalate cords, and polycarbonate urethane spacers to stabilize the functional spinal unit and preserve the adjacent motion after surgeries. This was a retrospective cohort study to compare the effect of Dynesys for treating degenerative lumbar diseases with posterior lumbar interbody fusion (PLIF) based on short term followup.

Materials and methods: Seventy five consecutive patients of lumbar degenerative disease operated between October 2010 and November 2012 were studied with a minimum followup of 2 years. Patients were divided into two groups according to the different surgeries. 30 patients underwent decompression and implantation of Dynesys in two levels (n = 29) or three levels (n = 1) and 45 patients underwent PLIF in two levels (n = 39) or three levels (n = 6). Clinical and radiographic outcomes between two groups were reviewed.

Results: Thirty patients (male:17, female:13) with a mean age of 55.96 ± 7.68 years were included in Dynesys group and the PLIF group included 45 patients (male:21, female:24) with a mean age of 54.69 ± 3.26 years. The average followup in Dynesys group and PLIF group was 2.22 ± 0.43 year (range 2-3.5 year) and 2.17 ± 0.76 year (range 2-3 year), respectively. Dynesys group showed a shorter operation time (141.06 ± 11.36 min vs. 176.98 ± 6.72 min, P < 0.001) and less intraoperative blood loss (386.76 ± 19.44 ml vs. 430.11 ± 24.72 ml, P < 0.001). For Dynesys group, visual analogue scale (VAS) for back and leg pain improved from 6.87 ± 0.80 to 2.92 ± 0.18 and 6.99 ± 0.81 to 3.25 ± 0.37, (both P < 0.001) and for PLIF, VAS for back and leg pain also improved significantly (6.97 ± 0.84-3.19 ± 0.19 and 7.26 ± 0.76-3.56 ± 0.38, both P < 0.001). Significant improvement was found at final followup in both groups in Oswestry disability index (ODI) score (both P < 0.001). Besides, Dynesys group showed a greater improvement in ODI and VAS back and leg pain scores compared with the PLIF group (P < 0.001, P = 0.009 and P = 0.031, respectively). For radiological, height of the operated level was found increased in both groups (both P < 0.001), but there was no difference between two groups (P = 0.93). For range of motion (ROM) of operated level, significant decrease was found in both groups (P < 0.001), but Dynesys showed a higher preservation of motion at the operative levels (P < 0.001). However, no significant difference was found in the percentage change of ROM of adjacent levels between Dynesys and PLIF (0.74 ± 8.92% vs. 0.92 ± 4.52%, P = 0.91). Some patients suffered from degeneration of adjacent intervertebral disc at final followup, but there was no significant difference in adjacent intervertebral disc degeneration between two groups (P = 0.71). Moreover, there were no differences in complications between Dynesys and PLIF (P = 0.90), although the incidence of complication in Dynesys was lower than PLIF (16.67% vs. 17.78%).

Conclusion: Dynamic stabilization system treating lumbar degenerative disease showed clinical benefits with motion preservation of the operated segments, but does not have the significant advantage on motion preservation at adjacent segments, to avoid the degeneration of adjacent intervertebral disk.

No MeSH data available.


Related in: MedlinePlus