Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Clinical Experience of the Dynamic Stabilization System for the Degenerative Spine Disease

  • Lee, Soo-Eon (Department of Neurosurgery Seoul National University College of Medicine) ;
  • Park, Sung-Bae (Department of Neurosurgery Seoul National University College of Medicine) ;
  • Jahng, Tae-Ahn (Department of Neurosurgery Seoul National University College of Medicine) ;
  • Chung, Chun-Kee (Department of Neurosurgery Seoul National University College of Medicine) ;
  • Kim, Hyun-Jib (Department of Neurosurgery Seoul National University College of Medicine)
  • Published : 2008.05.31
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Abstract

Objective : The aim of the present study was to assess the safety and efficacy of the dynamic stabilization system in the treatment of degenerative spinal diseases. Methods : The study population included 20 consecutive patients (13 females, 7 males) with a mean age of $61{\pm}6.98$ years (range 46-70) who underwent decompression and dynamic stabilization with the Dynesys system between January 2005 and August 2006. The diagnoses included spinal stenosis with degenerative spondylolisthesis (9/20, 45%), degenerative spinal stenosis (5/20, 25%), adjacent segmental disease after fusion (3/20, 15%), spinal stenosis with degenerative scoliosis (2/20, 10%) and recurrent intervertebral lumbar disc herniation (1/20, 5%). All of the patients completed the visual analogue scale (VAS) and the Korean version of the Oswestry Disability Index (ODI). The following radiologic parameters were measured in all patients : global lordotic angles and segmental lordotic angles (stabilized segments, above and below adjacent segments). The range of motion (ROM) was then calculated. Results : The mean follow-up period was $27.25{\pm}5.16$ months (range 16-35 months), and 19 patients (95%) were available for follow-up. One patient had to have the implant removed. There were 30 stabilized segments in 19 patients. Monosegmental stabilization was performed in 9 patients (47.3%), 9 patients (47.3%) underwent two segmental stabilizations and one patient (5.3%) underwent three segmental stabilizations. The most frequently treated segment was L4-5 (15/30, 50%), followed by L3-4 (12/30, 40%) and L5-S1 (3/30, 10%). The VAS decreased from $8.55{\pm}1.21$ to $2.20{\pm}1.70$ (p<0.001), and the patients' mean score on the Korean version of the ODI improved from $79.58%{\pm}15.93%$ to $22.17%{\pm}17.24%$ (p<0.001). No statistically significant changes were seen on the ROM at the stabilized segments (p=0.502) and adjacent segments (above segments, p=0.453, below segments, p=0.062). There were no patients with implant failure. Conclusion : The results of this study show that the Dynesys system could preserve the motion of stabilized segments and provide clinical improvement in patients with degenerative spinal stenosis with instability. Thus, dynamic stabilization systems with adequate decompression may be an alternative surgical option to conventional fusion in selected patients.

Keywords

References

  1. Bastian L, Lange U, Knop C, Tusch G, Blauth M : Evaluation of the mobility of adjacent segments after posterior thoracolumbar fixation : a biomechanical study. Eur Spine J 10 : 295-300, 2001 https://doi.org/10.1007/s005860100278
  2. Bordes-Monmeneu M, Bordes-Garcia V, Rodrigo-Baeza F, Saez D : [System of dynamic neutralization in the lumbar spine : experience on 94 cases.]. Neurocirugia (Astur) 16 : 499-506, 2005 https://doi.org/10.1016/S1130-1473(05)70378-X
  3. Cakir B, Ulmar B, Koepp H, Huch K, Puhl W, Richter M : [Posterior dynamic stabilization as an alternative for dorso-ventral fusion in spinal stenosis with degenerative instability]. Z Orthop Ihre Grenzgeb 141 : 418-424, 2003 https://doi.org/10.1055/s-2003-41568
  4. Chou WY, Hsu CJ, Chang WN, Wong CY : Adjacent segment degeneration after lumbar spinal posterolateral fusion with instrumentation in elderly patients. Arch Orthop Trauma Surg 122 : 39-43, 2002 https://doi.org/10.1007/s004020100314
  5. Fritzell P, Hagg O, Nordwall A : Complications in lumbar fusion surgery for chronic low back pain : comparison of three surgical techniques used in a prospective randomized study. A report from the Swedish Lumbar Spine Study Group. Eur Spine J 12 : 178-189, 2003
  6. Fritzell P, Hagg O, Wessberg P, Nordwall A : Chronic low back pain and fusion : a comparison of three surgical techniques : a prospective multicenter randomized study from the Swedish lumbar spine study group. Spine 27 : 1131-1141, 2002 https://doi.org/10.1097/00007632-200206010-00002
  7. Garner MD, Wolfe SJ, Kuslich SD : Development and preclinical testing of a new tension-band device for the spine : the Loop system. Eur Spine J 11 (Suppl 2) : S186-191, 2002 https://doi.org/10.1007/s005860100342
  8. Grob D, Benini A, Junge A, Mannion AF : Clinical experience with the Dynesys semirigid fixation system for the lumbar spine : surgical and patient-oriented outcome in 50 cases after an average of 2 years. Spine 30 : 324-331, 2005 https://doi.org/10.1097/01.brs.0000152584.46266.25
  9. Guigui P, Wodecki P, Bizot P, Lambert P, Chaumeil G, Deburge A : [Long-term influence of associated arthrodesis on adjacent segments in the treatment of lumbar stenosis: a series of 127 cases with 9-year follow-up]. Rev Chir Orthop Reparatrice Appar Mot 86 : 546-557, 2000
  10. Lehmann TR, Spratt KF, Tozzi JE, Weinstein JN, Reinarz SJ, el-Khoury GY, et al : Long-term follow-up of lower lumbar fusion patients. Spine 12 : 97-104, 1987 https://doi.org/10.1097/00007632-198703000-00004
  11. Putzier M, Schneider SV, Funk JF, Tohtz SW, Perka C : The surgical treatment of the lumbar disc prolapse : nucleotomy with additional transpedicular dynamic stabilization versus nucleotomy alone. Spine 30 : E109-114, 2005 https://doi.org/10.1097/01.brs.0000154630.79887.ef
  12. Schnake KJ, Schaeren S, Jeanneret B : Dynamic stabilization in addition to decompression for lumbar spinal stenosis with degenerative spondylolisthesis. Spine 31 : 442-449, 2006 https://doi.org/10.1097/01.brs.0000200092.49001.6e
  13. Schwarzenbach O, Berlemann U, Stoll TM, Dubois G : Posterior dynamic stabilization systems : DYNESYS. Orthop Clin North Am 36 : 363-372, 2005 https://doi.org/10.1016/j.ocl.2005.03.001
  14. Sengupta DK : Point of view : Dynamic stabilization in addition to decompression for lumbar spinal stenosis with degenerative spondylolisthesis. Spine 31 : 450, 2006 https://doi.org/10.1097/01.brs.0000200051.24623.33
  15. Sengupta DK, Mulholland RC : Fulcrum assisted soft stabilization system: a new concept in the surgical treatment of degenerative low back pain. Spine 30 : 1019-1029; discussion 1030, 2005 https://doi.org/10.1097/01.brs.0000160986.39171.4d
  16. Stoll TM, Dubois G, Schwarzenbach O : The dynamic neutralization system for the spine : a multi-center study of a novel non-fusion system. Eur Spine J 11 (Suppl 2) : S170-178, 2002
  17. Welch WC, Cheng BC, Awad TE, Davis R, Maxwell JH, Delamarter R, et al : Clinical outcomes of the Dynesys dynamic neutralization system : 1-year preliminary results. Neurosurg Focus 22 : E8, 2007