1
|
Heard JC, Lee Y, Lambrechts MJ, Berthiaume E, D'Antonio ND, Bodnar J, Paulik J, Mangan JJ, Canseco JA, Kurd MF, Kaye ID, Vaccaro AR, Kepler CK, Schroeder GD, Hilibrand AS. The impact of demineralized bone matrix characteristics on pseudarthrosis and surgical outcomes after posterolateral lumbar decompression and fusion. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2023; 14:194-200. [PMID: 37448499 PMCID: PMC10336891 DOI: 10.4103/jcvjs.jcvjs_45_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 05/15/2023] [Indexed: 07/15/2023] Open
Abstract
Objectives The objectives of our study were to compare the fusion rates and surgical outcomes of lumbar fusion surgery based on the (1) type of demineralized bone matrix (DBM) carrier allograft, (2) the presence/absence of a carrier, and (3) the presence of bone fibers in DBM. Methods Patients >18 years of age who underwent single-level posterolateral decompression and fusion (PLDF) between L3 and L5 between 2014 and 2021 were retrospectively identified. We assessed bone grafts based on carrier type (no carrier, sodium hyaluronate carrier, and glycerol carrier) and the presence of bone fibers. Fusion status was determined based on a radiographic assessment of bony bridging, screw loosening, or change in segmental lordosis >5°. Analyses were performed to assess fusion rates and surgical outcomes. Results Fifty-four patients were given DBM with a hyaluronate carrier, 75 had a glycerol carrier, and 94 patients were given DBM without a carrier. DBM carrier type, bone fibers, and carrier presence had no impact on 90-day readmission rates (P = 0.195, P = 0.099, and P = 1.000, respectively) or surgical readmissions (P = 0.562, P = 0.248, and P = 0.640, respectively). Multivariable logistic regression analysis found that type of carrier, presence of fibers (odds ratio [OR] = 1.106 [0.524-2.456], P = 0.797), and presence of a carrier (OR = 0.701 [0.370-1.327], P = 0.274) were also not significantly associated with successful fusion likelihood. Conclusion Our study found no significant differences between DBM containing glycerol, sodium hyaluronate, or no carrier regarding fusion rates or surgical outcomes after single-level PLDF. Bone particulates versus bone fibers also had no significant differences regarding the likelihood of bony fusion.
Collapse
Affiliation(s)
| | - Yunsoo Lee
- Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Mark J. Lambrechts
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO, USA
| | | | | | - John Bodnar
- Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - John Paulik
- Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | | | | | - Mark F. Kurd
- Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - I. David Kaye
- Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | | | | | | | | |
Collapse
|
2
|
Lumbar Stabilization with DSS-HPS ® System: Radiological Outcomes and Correlation with Adjacent Segment Degeneration. Diagnostics (Basel) 2021; 11:diagnostics11101891. [PMID: 34679589 PMCID: PMC8534523 DOI: 10.3390/diagnostics11101891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/06/2021] [Accepted: 10/11/2021] [Indexed: 11/30/2022] Open
Abstract
Arthrodesis has always been considered the main treatment of degenerative lumbar disease. Adjacent segment degeneration is one of the major topics related to fusion surgery. Non-fusion surgery may prevent this because of the protective effect of persisting segmental motion. The aims of the study were (1) to describe the radiological outcomes in the adjacent vertebral segment after lumbar stabilization with DSS-HPS® system and (2) to verify the hypothesis that this system prevents the degeneration of the adjacent segment. This is a retrospective monocentric analysis of twenty-seven patients affected by degenerative lumbar disease underwent spinal hybrid stabilization with the DSS-HPS® system between January 2016 and January 2019. All patients completed 1-year radiological follow-up. Preoperative X-rays and magnetic resonance images, as well as postoperative radiographs at 1, 6 and 12 months, were evaluated by one single observer. Pre- and post-operative anterior and posterior disc height at the dynamic (DL) and adjacent level (AL) were measured; segmental angle (SA) of the dynamized level were measured. There was a statistically significant decrease of both anterior (p = 0.0003 for the DL, p = 0.036 for the AL) and posterior disc height (p = 0.00000 for the DL, p = 0.00032 for the AL); there were a statistically significant variations of the segmental angle (p = 0.00000). Eleven cases (40.7%) of radiological progression of disc degeneration were found. The DSS-HPS® system does not seem to reduce progression of lumbar disc degeneration in a radiologic evaluation, both in the dynamized and adjacent level.
Collapse
|
3
|
Krieg SM, Balser N, Pape H, Sollmann N, Albers L, Meyer B. Topping-off technique for stabilization of lumbar degenerative instabilities in 322 patients. J Neurosurg Spine 2020; 32:366-372. [PMID: 31731274 DOI: 10.3171/2019.8.spine181434] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 08/21/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Semi-rigid instrumentation (SRI) was introduced to take advantage of the concept of load sharing in surgery for spinal stabilization. The authors investigated a topping-off technique in which interbody fusion is not performed in the uppermost motion segment, thus creating a smooth transition from stabilized to free motion segments. SRI using the topping-off technique also reduces the motion of the adjacent segments, which may reduce the risk of adjacent segment disease (ASD), a frequently observed sequela of instrumentation and fusion, but this technique may also increase the possibility of screw loosening (SL). In the present study the authors aimed to systematically evaluate reoperation rates, clinical outcomes, and potential risk factors and incidences of ASD and SL for this novel approach. METHODS The authors collected data for the first 322 patients enrolled at their institution from 2009 to 2015 who underwent surgery performed using the topping-off technique. Reoperation rates, patient satisfaction, and other outcome measures were evaluated. All patients underwent pedicle screw-based semi-rigid stabilization of the lumbar spine with a polyetheretherketone (PEEK) rod system. RESULTS Implantation of PEEK rods during revision surgery was performed in 59.9% of patients. A median of 3 motion segments (range 1-5 segments) were included and a median of 2 motion segments (range 0-4 segments) were fused. A total of 89.4% of patients underwent fusion, 73.3% by transforaminal lumbar interbody fusion (TLIF), 18.4% by anterior lumbar interbody fusion (ALIF), 3.1% by extreme lateral interbody fusion (XLIF), 0.3% by oblique lumbar interbody fusion (OLIF), and 4.9% by combined approaches in the same surgery. Combined radicular and lumbar pain according to a visual analog scale was reduced from 7.9 ± 1.0 to 4.0 ± 3.1, with 56.2% of patients indicating benefit from surgery. After maximum follow-up (4.3 ± 1.8 years), the reoperation rate was 16.4%. CONCLUSIONS The PEEK rod concept including the topping-off principle seems safe, with at least average patient satisfaction in this patient group. Considering the low rate of first-tier surgeries, the presented results seem at least comparable to those of most other series. Follow-up studies are needed to determine long-term outcomes, particularly with respect to ASD, which might be reduced by the presented approach.
Collapse
Affiliation(s)
- Sandro M Krieg
- 1Department of Neurosurgery
- 2TUM-Neuroimaging Center, and
| | | | | | - Nico Sollmann
- 1Department of Neurosurgery
- 2TUM-Neuroimaging Center, and
- 3Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | | | | |
Collapse
|
4
|
Reoperation rates and risk factors for revision 4 years after dynamic stabilization of the lumbar spine. Spine J 2019; 19:113-120. [PMID: 29886162 DOI: 10.1016/j.spinee.2018.05.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 05/02/2018] [Accepted: 05/16/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The concept of dynamic stabilization (DS) of the lumbar spine for treatment of degenerative instability has been introduced almost two decades ago. Dynamic stabilization follows the principle of controlling movement in the coronal plane by providing load transfer of the spinal segment without fusion and, at the same time, reducing side effects such as adjacent segment disease (ASD). So far, only little is known about revision rates after DS due to ASD and screw loosening (SL). PURPOSE The present study aimed to evaluate the longitudinal revision rates following dynamic pedicle screw stabilization in the lumbar spine and to determine specific risk factors predictive for ASD, SL, and overall reoperation in a large cohort with considerable follow-up. DESIGN We carried out a post hoc analysis of a prospectively collected database in a level I spine center. PATIENTS EXAMPLE The patient sample comprised 283 (151 female/132 male) consecutive patients suffering from painful degenerative lumbar segmental instability with or without spinal stenosis who underwent DS of the lumbar spine (Ulrich Cosmic, Ulrich Medical, Ulm, Germany) between January 2008 and December 2011. OUTCOME MEASURES Longitudinal reoperation rate and risk factors predictive for revision surgery were evaluated. METHODS We analyzed the longitudinal reoperation rate due to ASD and SL and overall reoperation. Risk factors such as age, gender, body mass index, lumbar lordosis (LL), number of segments, and number of previous surgeries were taken into account. Regular and mixed model logistic regressions were performed to determine risk factors for revision surgery on a patient and on a screw level. RESULTS The mean age was 65.7±10.2 years (range 31-88). One hundred thirty-two patients were stabilized in 1 segment, 134 in 2 segments, 15 in 3 segments, and 2 patients in 4 segments. Reoperation rate for ASD and SL after 1 year was 7.4 %, after 2 years was 15.0%, and after a mean follow-up of 51.4±15 months was 22.6%. Reasons for revision were SL in 19 cases (6.6%), ASD in 39 cases (13.7%), SL and ASD in 6 cases, hematoma in 2 cases (0.7%), cerebrospinal fluid fistulae in 3 cases (1.1%), infection in 6 cases (2.1%), and implant failure in 1 case (0.4%). The patients' age, the number of stabilized segments, and the number of previous surgeries and postoperative LL had a significant influence on the probability for revision surgery. CONCLUSIONS Reoperation rates after DS of the lumbar spine are comparable with rigid fixations. The younger the patient and the more segments are involved, the lower the LL and the more previous surgeries were found, the higher was the risk of revision. Risk of revision was almost twice as high in men compared with women. We therefore conclude that for clear clinical indication and careful evaluation of preoperative imaging data, DS using the Cosmic system seems to be a possible option. The presented data will help to further tailor indication and patient selection.
Collapse
|
5
|
Khalifa AH, Stübig T, Meier O, Müller CW. Dynamic stabilization for degenerative diseases in the lumbar spine: 2 years results. Orthop Rev (Pavia) 2018; 10:7534. [PMID: 29770178 PMCID: PMC5937365 DOI: 10.4081/or.2018.7534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 01/24/2018] [Accepted: 01/25/2018] [Indexed: 12/26/2022] Open
Abstract
Following lumbar fusion, adjacent segment degeneration has been frequently reported. Dynamic systems are believed to reduce main fusion drawbacks. We conducted a retrospective study on patients with degenerative lumbar disease treated with posterior dynamic stabilization with monoaxial hinged pedicular screws and lumbar decompression. VAS and ODI were used to compare clinical outcomes. As radiological outcomes, LL and SVA were used. 51 patients were included with an average follow-up of 24 months. 13 patients were revised because of postoperative radiculopathy (n=4), subcutaneous hematoma (n=2), L5 screw malposition (n=1) and adjacent segment disease (n=6). The mean ODI score 41 preoperatively compared to 36 postoperatively. The mean VAS scores for back and leg pain were 5.3 and 4.2, respectively compared to 4.5 and 4.0 postoperatively. The mean SVA was 5.3 cm preoperatively, and 5.7 cm postoperatively. The mean LL was 47.5° preoperatively and 45.5° postoperatively. From our data, which fail to show significant improvements and reflect a high revision rate, we cannot generally recommend dynamic stabilization as an alternative to fusion. Comparative trials with longer follow-ups are required.
Collapse
Affiliation(s)
- Ahmed Hosny Khalifa
- Trauma Department, Hannover Medical School (MHH), Hannover.,Spine Center, Werner-Wicker-Clinic, Bad Wildungen, Germany
| | - Timo Stübig
- Trauma Department, Hannover Medical School (MHH), Hannover
| | - Oliver Meier
- Spine Center, Werner-Wicker-Clinic, Bad Wildungen, Germany
| | | |
Collapse
|
6
|
Aydin M, Sasani M, Oktenoglu T, Durmaz MO, Bozkus H, Keskin F, Ozer AF. Clinical evaluation of 34 cases treated with sequestrectomy: Minimum two year follow up. INTERNATIONAL JOURNAL OF SURGERY OPEN 2017. [DOI: 10.1016/j.ijso.2017.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
7
|
Lee CH, Jahng TA, Hyun SJ, Kim CH, Park SB, Kim KJ, Chung CK, Kim HJ, Lee SE. Dynamic stabilization using the Dynesys system versus posterior lumbar interbody fusion for the treatment of degenerative lumbar spinal disease: a clinical and radiological outcomes-based meta-analysis. Neurosurg Focus 2016; 40:E7. [PMID: 26721581 DOI: 10.3171/2015.10.focus15426] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The Dynesys, a pedicle-based dynamic stabilization (PDS) system, was introduced to overcome the drawbacks of fusion procedures. Nevertheless, the theoretical advantages of PDS over fusion have not been clearly confirmed. The aim of this study was to compare clinical and radiological outcomes of patients who underwent PDS using the Dynesys system with those who underwent posterior lumbar interbody fusion (PLIF). METHODS The authors searched PubMed, Embase, Web of Science, and the Cochrane Database. Studies that reported outcomes of patients who underwent PDS or PLIF for the treatment of degenerative lumbar spinal disease were included. The primary efficacy end points were perioperative outcomes. The secondary efficacy end points were changes in the Oswestry Disability Index (ODI) and back and leg pain visual analog scale (VAS) scores and in range of motion (ROM) at the treated and adjacent segments. A meta-analysis was performed to calculate weighted mean differences (WMDs), 95% confidence intervals, Q statistics, and I(2) values. Forest plots were constructed for each analysis group. RESULTS Of the 274 retrieved articles, 7 (which involved 506 participants [Dynesys, 250; PLIF, 256]) met the inclusion criteria. The Dynesys group showed a competitive advantage in mean surgery duration (20.73 minutes, 95% CI 8.76-32.70 minutes), blood loss (81.87 ml, 95% CI 45.11-118.63 ml), and length of hospital stay (1.32 days, 95% CI 0.23-2.41 days). Both the Dynesys and PLIF groups experienced improved ODI and VAS scores after 2 years of follow-up. Regarding the ODI and VAS scores, no statistically significant difference was noted according to surgical procedure (ODI: WMD 0.12, 95% CI -3.48 to 3.72; back pain VAS score: WMD -0.15; 95% CI -0.56 to 0.26; leg pain VAS score: WMD -0.07; 95% CI -0.47 to 0.32). The mean ROM at the adjacent segment increased in both groups, and there was no substantial difference between them (WMD 1.13; 95% CI -0.33 to 2.59). Although the United States is the biggest market for Dynesys, no eligible study from the United States was found, and 4 of 8 enrolled studies were performed in China. The results must be interpreted with caution because of publication bias. During Dynesys implantation, surgeons have to decide the length of the spacer and cord pretension. These values are debatable and can vary according to the surgeon's experience and the patient's condition. Differences between the surgical procedures were not considered in this study. CONCLUSIONS Fusion still remains the method of choice for advanced degeneration and gross instability. However, spinal degenerative disease with or without Grade I spondylolisthesis, particularly in patients who require a quicker recovery, will likely constitute the main indication for PDS using the Dynesys system.
Collapse
Affiliation(s)
- Chang-Hyun Lee
- Department of Neurosurgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang
| | - Tae-Ahn Jahng
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seongnam;,Seoul National University College of Medicine, Seoul
| | - Seung-Jae Hyun
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seongnam
| | - Chi Heon Kim
- Seoul National University College of Medicine, Seoul;,Department of Neurosurgery and.,Clinical Research Institute, Seoul National University Hospital, Seoul;,Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul; and
| | - Sung-Bae Park
- Department of Neurosurgery, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Ki-Jeong Kim
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seongnam
| | - Chun Kee Chung
- Seoul National University College of Medicine, Seoul;,Department of Neurosurgery and.,Clinical Research Institute, Seoul National University Hospital, Seoul;,Neuroscience Research Institute, Seoul National University Medical Research Center, Seoul; and
| | - Hyun-Jib Kim
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seongnam
| | - Soo-Eon Lee
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seongnam
| |
Collapse
|
8
|
Schwaiger BJ, Behr M, Gersing AS, Meyer B, Zimmer C, Kirschke JS, Ryang YM, Ringel F. Computed Tomography Findings Associated with Clinical Outcome After Dynamic Posterior Stabilization of the Lumbar Spine. World Neurosurg 2016; 93:306-14. [PMID: 27327251 DOI: 10.1016/j.wneu.2016.06.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 06/09/2016] [Accepted: 06/10/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate whether preoperative multirow detector computed tomography (MDCT) findings were associated with clinical outcome 24 months after dynamic stabilization for painful degenerative lumbar spine disease. METHODS Preoperative MDCT examinations of 63 patients (66 ± 11.7 years; 60% women) treated with a dynamic screw rod system for painful degenerative segmental instability with/without spinal stenosis were assessed for quantitative and qualitative parameters defining degenerative changes of the thoracolumbar spine, including grades of disc herniation, degenerative spondylolisthesis, vertebral body sclerosis, cross-sectional area of the spinal canal at disc level, intervertebral disc height, ancillary bone mineral density, and anteroposterior diameter of intervertebral foramina. Clinical performance was assessed at baseline and 24 months with quantitative scales, including the Oswestry Disability Index and Short-Form 36 physical component summary. For statistical analysis classification and regression trees, linear regression and nonparametric tests were used. RESULTS Clinical scores improved substantially over 24 months compared with preoperative values (delta Oswestry Disability Index -32.1 ± 17.2, delta Short-Form 36 physical component summary 4.9 ± 2.3). Physical component summary improvement was significantly better in patients with lower grades of disc herniation (P < 0.001) and/or spondylolisthesis (P = 0.011), lower cross-sectional area of the spinal canal (P = 0.043), high intervertebral disc height (P = 0.006), and high grades of vertebral body sclerosis (P = 0.002). Patients with high bone mineral density and initially low diameter of intervertebral foramina showed a significantly better improvement of Oswestry Disability Index (P < 0.05). CONCLUSIONS Clinical improvement after dynamic stabilization was significantly associated with 7 independent baseline imaging findings. Preoperative evaluation of these MDCT parameters may improve therapy selection for patients with degenerative lumbar spine disease.
Collapse
Affiliation(s)
- Benedikt J Schwaiger
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, München, Germany.
| | - Michael Behr
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Alexandra S Gersing
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Jan S Kirschke
- Department of Diagnostic and Interventional Neuroradiology, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Yu-Mi Ryang
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Florian Ringel
- Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, München, Germany; Department of Neurosurgery, Universitätsmedizin Mainz, University of Mainz, Mainz, Germany
| |
Collapse
|
9
|
Clinical Outcomes and Complications After Pedicle-anchored Dynamic or Hybrid Lumbar Spine Stabilization. ACTA ACUST UNITED AC 2015; 28:E439-48. [DOI: 10.1097/bsd.0000000000000092] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
10
|
Qian W, Yin H, Yang HL, Li C, Hui M. Pedicle screw-based dynamic stabilisation systems versus pedicle screw-based rigid fusion system for lumbar degenerative diseases. Hippokratia 2015. [DOI: 10.1002/14651858.cd011886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Weiqing Qian
- The First Affiliated Hospital of Soochow University; Soochow City China
- The Third Affiliated Hospital of Nanjing University of Traditional Chinese Medicine; Department of Orthopedics and Traumatology; Nanjing China
| | - Hong Yin
- The Third Affiliated Hospital of Nanjing University of Traditional Chinese Medicine; Department of Orthopedics and Traumatology; Nanjing China
| | - Hui-Lin Yang
- The First Affiliated Hospital of Soochow University; Department of Orthopedics; Soochow City China
| | - Chunbo Li
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine; Shanghai Key Laboratory of Psychotic Disorders; 600 Wan Ping Nan Road Shanghai China 200030
| | - Ma Hui
- The affiliated Hospital of the Second Military Medical University; Department of Orthopedics, Changhai Hospital; Shanghai China
| |
Collapse
|
11
|
Ozer AF, Suzer T, Sasani M, Oktenoglu T, Cezayirli P, Marandi HJ, Erbulut DU. Simple facet joint repair with dynamic pedicular system: Technical note and case series. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2015; 6:65-8. [PMID: 25972711 PMCID: PMC4426524 DOI: 10.4103/0974-8237.156049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: Facet joints are important anatomical structures for the stability of spine. Surgical or degenerative damage to a facet joint may lead to spinal instability and causes clinical problems. This article explains the importance of facet joints, reviews facet replacement systems, and describes a simple and effective method for facet replacement after surgical removal of facet joints. Materials and Methods: Ten patients were operated with the diagnosis of unilateral nerve root compression secondary to facet degeneration. The hypertrophic facet joints were removed with microsurgical techniques and the roots were decompressed. Then, a unilateral artificial facet joint was created using two hinged screws and a dynamic rod. Results: The clinical outcome of all the patients was determined good or excellent at second and last follow-up (mean 13.3 months) controls using visual analog scale (VAS) and Oswestry Disability Index (ODI) scores. Radiological evaluations also demonstrated no implant-related complications. Conclusions: The authors suggest that, if removal of a facet joint is necessary to decompress the nerve roots, the joint can be replaced by a construct composed of two hinged screws connected by a dynamic rod. This simple system mimics the function of a normal facet joint and is an effective technique for unilateral facet joint replacement.
Collapse
Affiliation(s)
- Ali Fahir Ozer
- Koc University Medical School, Neurosurgery Department, Istanbul, Turkey
| | - Tuncer Suzer
- Koc University Medical School, Neurosurgery Department, Istanbul, Turkey
| | - Mehdi Sasani
- American Hospital, Neurosurgery Department, Istanbul, Turkey
| | - Tunc Oktenoglu
- American Hospital, Neurosurgery Department, Istanbul, Turkey
| | - Phillip Cezayirli
- Albert Einstein College of Medicine/Montefiore Medical Center, Neurosurgery Residency, New York, USA
| | - Hosein Jafari Marandi
- Iran University of Medical Science, Hazrat Rasoul Medical Complex, Spine Surgery Division, Tehran, Iran
| | | |
Collapse
|
12
|
Abstract
STUDY DESIGN The biomechanical effects of Dynesys and Cosmic fixators on transition and adjacent segments were evaluated using the finite-element method. OBJECTIVE This study investigated the load-transferring mechanisms of 2 dynamic fixators and the fixator-induced effects on the junctional problem of the adjacent segments. SUMMARY OF BACKGROUND DATA The mobility and flexibility of Dynesys screw-spacer and Cosmic screw-hinge joints preserve motion and share loads for the transition segment. However, the differences in tissue responses and fixator mechanisms among these 2 fixators have not been investigated extensively. METHODS A lumbosacral model from L1 to S1 levels was developed and subjected to muscular contraction, ligamentous interconnection, compressive force, and trunk moment. A static fixator was instrumented at the moderately degenerative L4-L5 segment to serve as a comparison baseline. Subsequently, the 2 fixators were instrumented at the mildly degenerative L3-L4 segment. The tissue responses of the adjacent segments and the load transmission at the screw-spacer and bone-screw interfaces were compared. RESULTS Both systems show the ability to protect the transition segment but deteriorate the adjacent segments. The screw-hinge joint and the stiffer rod of the Cosmic system significantly constrained the motion pattern of the transition segment. Comparatively, the Dynesys screw-spacer interfaces make contact with and depart from each other during motion; thus providing higher mobility to the transition segment. However, the highly stressed distribution at the Cosmic bone-screw causes the screw and hinge prone to pullout and fatigue failures. CONCLUSION Cosmic fixation can better protect the disc and facet joint of the transition segment than can the Dynesys. However, the screw-hinge joint strictly constrains intersegmental motion and deteriorates the junctional problem. The Cosmic system can be chosen to treat more severely degenerative transition segments. With higher flexibility, the Dynesys system is recommended for the transition segment that is healthy or mildly degenerative. LEVEL OF EVIDENCE N/A.
Collapse
|
13
|
Dynamic stabilization for challenging lumbar degenerative diseases of the spine: a review of the literature. Adv Orthop 2013; 2013:753470. [PMID: 23662211 PMCID: PMC3639681 DOI: 10.1155/2013/753470] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 03/07/2013] [Indexed: 12/14/2022] Open
Abstract
Fusion and rigid instrumentation have been currently the mainstay for the surgical treatment of degenerative diseases of the spine over the last 4 decades. In all over the world the common experience was formed about fusion surgery. Satisfactory results of lumbar spinal fusion appeared completely incompatible and unfavorable within years. Rigid spinal implants along with fusion cause increased stresses of the adjacent segments and have some important disadvantages such as donor site morbidity including pain, wound problems, infections because of longer operating time, pseudarthrosis, and fatigue failure of implants. Alternative spinal implants were developed with time on unsatisfactory outcomes of rigid internal fixation along with fusion. Motion preservation devices which include both anterior and posterior dynamic stabilization are designed and used especially in the last two decades. This paper evaluates the dynamic stabilization of the lumbar spine and talks about chronologically some novel dynamic stabilization devices and thier efficacies.
Collapse
|
14
|
Abstract
Interspinous spacers were developed to treat local deformities such as degenerative spondylolisthesis. To treat patients with chronic instability, posterior pedicle fixation and rod-based dynamic stabilization systems were developed as alternatives to fusion surgeries. Dynamic stabilization is the future of spinal surgery, and in the near future, we will be able to see the development of new devices and surgical techniques to stabilize the spine. It is important to follow the development of these technologies and to gain experience using them. In this paper, we review the literature and discuss the dynamic systems, both past and present, used in the market to treat lumbar degeneration.
Collapse
|