1
|
Jiang G, Xu L, Ma Y, Guan J, Feng N, Qiu Z, Zhou S, Li W, Yang Y, Qu Y, Zhao H, Li Z, Yu X. Clinical study on freehand of bicortical sacral screw fixation with the assistance of torque measurement device. BMC Musculoskelet Disord 2024; 25:516. [PMID: 38970034 PMCID: PMC11225279 DOI: 10.1186/s12891-024-07627-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 06/25/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND Sacral screw loosening is a typical complication after internal fixation surgery through the vertebral arch system. Bicortical fixation can successfully prevent screw loosening, and how improving the rate of bicortical fixation is a challenging clinical investigation. OBJECTIVE To investigate the feasibility of improving the double corticality of sacral screws and the optimal fixation depth to achieve double cortical fixation by combining the torque measurement method with bare hands. METHODS Ninety-seven cases of posterior lumbar internal fixation with pedicle root system were included in this study. Based on the tactile feedback of the surgeon indicating the expected penetration of the screw into the contralateral cortex of the sacrum, the screws were further rotated by 180°, 360°, or 720°, categorized into the bicortical 180° group, bicortical 360° group, and bicortical 720° group, respectively. Intraoperatively, the torque during screw insertion was recorded. Postoperatively, the rate of double-cortex engagement was evaluated at 7 days, and screw loosening was assessed at 1 year follow-up. RESULTS The bicortical rates of the 180° group, 360° group, and 720° group were 66.13%, 91.18% and 93.75%, respectively. There were statistically significant differences between the 180° group and both the 360° and 720° groups (P < 0.05). However, there was no statistically significant difference between the 360° group and the 720° group (P > 0.05).The rates of loosening of sacral screws in the 180° group, 360° group, and 720° group were 20.97%, 7.35% and 7.81%, respectively. There were statistically significant differences between the 180° group and both the 360° and 720° groups (P < 0.05). However, there was no statistically significant difference between the 360° group and the 720° group (P > 0.05). The bicortical 360° group achieved a relatively satisfactory rate of dual cortical purchase while maintaining a lower rate of screw loosening. CONCLUSION Manual insertion of sacral screws with the assistance of a torque measurement device can achieve a relatively satisfactory dual cortical purchase rate while reducing patient hospitalization costs.
Collapse
Affiliation(s)
- Guozheng Jiang
- Department of Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, 100700, China
| | - Luchun Xu
- Department of Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, 100700, China
| | - Yukun Ma
- Department of Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, 100700, China
| | - Jianbin Guan
- Department of Honghui-Hospital, Xi'an Jiaotong University, Xi'an, 710054, China
| | - Ningning Feng
- Department of Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, 100700, China
| | - Ziye Qiu
- Department of Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, 100700, China
| | - Shibo Zhou
- Department of Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, 100700, China
| | - Wenhao Li
- Department of Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, 100700, China
| | - Yongdong Yang
- Department of Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, 100700, China
| | - Yi Qu
- Department of Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, 100700, China
| | - He Zhao
- Department of Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, 100700, China
| | - Zeyu Li
- Department of Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, 100700, China
| | - Xing Yu
- Department of Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine, Beijing, 100700, China.
| |
Collapse
|
2
|
Nassr A, Coric D, Pinter ZW, Sebastian AS, Freedman BA, Whiting D, Chahlavi A, Pirris S, Phan N, Meyer SA, Tahernia AD, Sandhu F, Deutsch H, Potts EA, Cheng J, Chi JH, Groff M, Anekstein Y, Steinmetz MP, Welch WC. Lumbar Facet Arthroplasty Versus Fusion for Grade-I Degenerative Spondylolisthesis with Stenosis: A Prospective Randomized Controlled Trial. J Bone Joint Surg Am 2024; 106:1041-1053. [PMID: 38713762 DOI: 10.2106/jbjs.23.00719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/09/2024]
Abstract
BACKGROUND The comparative effectiveness of decompression plus lumbar facet arthroplasty versus decompression plus instrumented lumbar spinal fusion in patients with lumbar spinal stenosis and grade-I degenerative spondylolisthesis is unknown. METHODS In this randomized, controlled, Food and Drug Administration Investigational Device Exemption trial, we assigned patients who had single-level lumbar spinal stenosis and grade-I degenerative spondylolisthesis to undergo decompression plus lumbar facet arthroplasty (arthroplasty group) or decompression plus fusion (fusion group). The primary outcome was a predetermined composite clinical success score. Secondary outcomes included the Oswestry Disability Index (ODI), visual analog scale (VAS) back and leg pain, Zurich Claudication Questionnaire (ZCQ), Short Form (SF)-12, radiographic parameters, surgical variables, and complications. RESULTS A total of 321 adult patients were randomized in a 2:1 fashion, with 219 patients assigned to undergo facet arthroplasty and 102 patients assigned to undergo fusion. Of these, 113 patients (51.6%) in the arthroplasty group and 47 (46.1%) in the fusion group who had either reached 24 months of postoperative follow-up or were deemed early clinical failures were included in the primary outcome analysis. The arthroplasty group had a higher proportion of patients who achieved composite clinical success than did the fusion group (73.5% versus 25.5%; p < 0.001), equating to a between-group difference of 47.9% (95% confidence interval, 33.0% to 62.8%). The arthroplasty group outperformed the fusion group in most patient-reported outcome measures (including the ODI, VAS back pain, and all ZCQ component scores) at 24 months postoperatively. There were no significant differences between groups in surgical variables or complications, except that the fusion group had a higher rate of developing symptomatic adjacent segment degeneration. CONCLUSIONS Among patients with lumbar spinal stenosis and grade-I degenerative spondylolisthesis, lumbar facet arthroplasty was associated with a higher rate of composite clinical success than fusion was at 24 months postoperatively. LEVEL OF EVIDENCE Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.
Collapse
Affiliation(s)
- Ahmad Nassr
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Domagoj Coric
- Carolinas Neurosurgery & Spine Associates, SpineFirst Atrium Health, Charlotte, North Carolina
| | | | | | - Brett A Freedman
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Ali Chahlavi
- Ascension St. Vincent's Spine & Brain Institute, Jacksonville, Florida
- Mayo Clinic Florida, Jacksonville, Florida
| | - Stephen Pirris
- Ascension St. Vincent's Spine & Brain Institute, Jacksonville, Florida
- Mayo Clinic Florida, Jacksonville, Florida
| | | | - Scott A Meyer
- Atlantic Neurosurgical Specialists, Altair Health, Morristown, New Jersey
| | | | - Faheem Sandhu
- MedStar Georgetown University Hospital, Washington DC
| | | | - Eric A Potts
- Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | | | - John H Chi
- Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Yoram Anekstein
- Shamir Medical Center, Zerifin, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv Israel
| | - Michael P Steinmetz
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - William C Welch
- Department of Neurological Surgery, Cleveland Clinic Foundation, Cleveland, Ohio
| |
Collapse
|
3
|
Katiyar P, Malka M, Reyes JL, Lombardi JM, Lenke LG, Sardar ZM. Innovative technologies in thoracolumbar and lumbar spine surgery failing to reach standard of care: state-of-art review. Spine Deform 2024:10.1007/s43390-024-00898-9. [PMID: 38795313 DOI: 10.1007/s43390-024-00898-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 05/15/2024] [Indexed: 05/27/2024]
Abstract
PURPOSE To evaluate previously popular technologies in the field of spine surgery, and to better understand their advantages and limitations to the current standards of care. Spine surgery is an ever-evolving field that serves to resolve various spinal pathologies in patients of all ages. While there are established treatments for various conditions, such as lumbar spinal stenosis, idiopathic scoliosis, and degenerative lumbar disease, there is always further research and development in these areas to produce innovative technologies that can lead to better outcomes. As this process progresses, we must remind ourselves of previously tried and tested inventions and their outcomes that have fallen short of becoming a standard to ensure we are able to learn lessons from the past. METHODS A thorough literature review was conducted with the aim of compiling literature of previously utilized technologies in spine surgery. Biomedical databases were utilized to gather relevant articles including PubMed, MEDLINE, and EMBASE. Emphasis was placed on gathering articles with technologies or therapeutics aimed at treating common spinal pathologies including lumbar spinal stenosis (LSS), adolescent idiopathic scoliosis (AIS), and other degenerative lumbar spine diseases. The keywords used were: "failed technologies", "historical technologies", "spine surgery", "spinal stenosis", "adolescent idiopathic scoliosis", and "degenerative lumbar spine disease". A total of 47 articles were gathered after initial review. RESULTS Different technologies pertaining to spine surgery were identified and critically evaluated. Some of these technologies included X-STOP, Vertiflex, Vertebral Body Stapling, and Dynesys. These technologies were evaluated for their strengths and limitations across their spinal pathology applications. While each type of technology had their benefits, the data tended to be mixed with various limitations across studies. CONCLUSION These technologies have been trialed in the field of spine surgery across various spinal pathologies, but still prove of limited efficacy and shortcomings to the current standards of care.
Collapse
Affiliation(s)
- Prerana Katiyar
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, Och Spine Hospital, New York-Presbyterian/Allen, New York, USA
| | - Matan Malka
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, Och Spine Hospital, New York-Presbyterian/Allen, New York, USA
| | - Justin L Reyes
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, Och Spine Hospital, New York-Presbyterian/Allen, New York, USA.
| | - Joseph M Lombardi
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, Och Spine Hospital, New York-Presbyterian/Allen, New York, USA
| | - Lawrence G Lenke
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, Och Spine Hospital, New York-Presbyterian/Allen, New York, USA
| | - Zeeshan M Sardar
- Department of Orthopaedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, Och Spine Hospital, New York-Presbyterian/Allen, New York, USA
| |
Collapse
|
4
|
Li J, Li Q, Deng Z, Wang L, Wang L, Song Y. Long-term Outcome of Isobar TTL System for the Treatment of Lumbar Degenerative Disc Diseases. Orthop Surg 2024; 16:912-920. [PMID: 38445544 PMCID: PMC10984823 DOI: 10.1111/os.14025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 02/03/2024] [Accepted: 02/06/2024] [Indexed: 03/07/2024] Open
Abstract
OBJECTIVE The Isobar TTL dynamic fixation system has demonstrated favorable outcomes in the short-term treatment of lumbar degenerative disc diseases (LDDs). However, there is a paucity of extensive research on the long-term effects of this system on LDDs. This study aimed to evaluate the long-term clinical and radiological outcomes of patients with LDDs who underwent treatment utilizing the Isobar TTL dynamic fixation system. METHODS The study analyzed the outcomes of 40 patients with LDDs who underwent posterior lumbar decompression and received single-segment Isobar TTL dynamic internal fixation at our hospital between June 2010 and December 2016. The evaluation of clinical therapeutic effect involved assessing postoperative pain levels using the visual analogue scale (VAS) and Oswestry disability index (ODI), both before surgery, 3 months after, and the final follow-up. To determine the preservation of functional motion in dynamically stable segments, we measured the range of motion (ROM) and disc height of stabilized and adjacent segments preoperatively and during the final follow-up. Additionally, we investigated the occurrence of adjacent segment degeneration (ASD). RESULTS Forty patients were evaluated, with an average age of 44.65 years and an average follow-up period of 79.37 months. Fourteen patients belonged to the spondylolisthesis group, while the remaining 26 were categorized under the stenosis or herniated disc group. The preoperative ROM of the stabilized segment exhibited a significant reduction from 8.15° ± 2.77° to 5.00° ± 1.82° at the final follow-up (p < 0.001). In contrast, there was a slight elevation in the ROM of the adjacent segment during the final follow-up, increasing from 7.68° ± 2.25° before surgery to 9.36° ± 1.98° (p < 0.001). The intervertebral space height (IH) in the stabilized segment exhibited a significant increase from 10.56 ± 1.99 mm before surgery to 11.39 ± 1.90 mm at the one-week postoperative follow-up (p < 0.001). Conversely, there was a notable decrease in the IH of the adjacent segment from 11.09 ± 1.82 mm preoperatively to 10.86 ± 1.79 mm at the one-week follow-up after surgery (p < 0.001). The incidence of ASD was 15% (6/40) after an average follow-up period of 79.37 months, with a rate of 15.38% (4/26) in the stenosis or herniated disc group and 14.29% (2/14) in the spondylolisthesis group; however, no statistically significant difference was observed in the occurrence of ASD among these groups (p > 0.05). CONCLUSION The Isobar TTL dynamic fixation system is an effective treatment for LDDs, improving pain relief, quality of life (QoL) and maintaining stabilized segmental motion. It has demonstrated excellent long-term clinical and radiographic results.
Collapse
Affiliation(s)
- Junhu Li
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital and West China School of Medicine, Sichuan University, Chengdu, China
| | - Qiujiang Li
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital and West China School of Medicine, Sichuan University, Chengdu, China
| | - Zhipeng Deng
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital and West China School of Medicine, Sichuan University, Chengdu, China
| | - Linnan Wang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital and West China School of Medicine, Sichuan University, Chengdu, China
| | - Lei Wang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital and West China School of Medicine, Sichuan University, Chengdu, China
| | - Yueming Song
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital and West China School of Medicine, Sichuan University, Chengdu, China
| |
Collapse
|
5
|
Karadag MK, Akgun MY, Basak AT, Ates O, Tepebasili MA, Gunerbuyuk C, Oktenoglu T, Sasani M, Ozer AF. Clinical and radiological analysis of the effects of three different lumbar transpedicular dynamic stabilization system on disc degeneration and regeneration. Front Surg 2023; 10:1297790. [PMID: 38162089 PMCID: PMC10757836 DOI: 10.3389/fsurg.2023.1297790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/17/2023] [Indexed: 01/03/2024] Open
Abstract
Objective This study aims to assess the clinical outcomes of three transpedicular dynamic systems in treating degenerative disc disease and evaluate their impact on both clinical and radiological aspects of the operated and adjacent segments. Materials and methods A total of 111 patients who underwent posterior transpedicular short-segment dynamic system procedures for treatment of degenerative disc disease were included. The patients were categorized into three groups, namely, Group 1 (Dynesys system, n = 38), Group 2 (Safinaz screw + PEEK rod, n = 37), and Group 3 (Safinaz screw + titanium rod, n = 36). Disc regeneration in the operated segment and disc degeneration in the operated, upper, and lower adjacent segments were assessed using the Pfirrmann Classification. Results Postoperatively, a statistically significant difference was observed in visual analog scale and Oswestry Disability Index scores (p < 0.001). However, no statistically significant difference was seen in disc degeneration/regeneration and degeneration scores of the upper and lower adjacent segments between the preoperative and postoperative groups (p = 0.763, p = 0.518, p = 0.201). Notably, a positive effect on disc regeneration at the operated level (32.4%) was observed. No significant differences were found between the groups in terms of operation rates, screw loosening, and screw breakage after adjacent segment disease (p > 0.05). Conclusion In patients without advanced degeneration, all three dynamic systems demonstrated the ability to prevent degeneration in the adjacent and operated segments while promoting regeneration in the operated segment. Beyond inhibiting abnormal movement in painful segments, maintaining physiological motion and providing axial distraction in the operated segment emerged as key mechanisms supporting regeneration.
Collapse
Affiliation(s)
| | - Mehmet Yigit Akgun
- Department of Neurosurgery, Koc University Hospital, Istanbul, Türkiye
- Spine Center, Koc University Hospital, Istanbul, Türkiye
| | | | - Ozkan Ates
- Department of Neurosurgery, Koc University Hospital, Istanbul, Türkiye
- Spine Center, Koc University Hospital, Istanbul, Türkiye
| | | | | | - Tunc Oktenoglu
- Department of Neurosurgery, Koc University Hospital, Istanbul, Türkiye
- Spine Center, Koc University Hospital, Istanbul, Türkiye
| | - Mehdi Sasani
- Department of Neurosurgery, Koc University Hospital, Istanbul, Türkiye
- Spine Center, Koc University Hospital, Istanbul, Türkiye
| | - Ali Fahir Ozer
- Department of Neurosurgery, Koc University Hospital, Istanbul, Türkiye
- Spine Center, Koc University Hospital, Istanbul, Türkiye
| |
Collapse
|
6
|
Calek AK, Widmer J, Fasser MR, Farshad M. Lumbar vertebropexy after unilateral total facetectomy. Spine J 2023; 23:1730-1737. [PMID: 37451550 DOI: 10.1016/j.spinee.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 07/02/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND CONTEXT Posterior decompression with spinal instrumentation and fusion is associated with well-known complications. Alternatives that include decompression and restoration of native stability of the motion segment without fusion continue to be explored, however, an ideal solution has yet to be identified. PURPOSE The aim of this study was to test two different synthetic lumbar vertebral stabilization techniques that can be used after unilateral total facetectomy. STUDY DESIGN Biomechanical cadaveric study. METHODS Twelve spinal segments were biomechanically tested after unilateral total facetectomy and stabilized with a FiberTape cerclage. The cerclage was pulled through the superior and inferior spinous process (interspinous technique) or through the spinous process and around both laminae (spinolaminar technique). The specimens were tested after (1) unilateral total facetectomy, (2) interspinous vertebropexy and (3) spinolaminar vertebropexy. The segments were loaded in flexion-extension (FE), lateral shear (LS), lateral bending (LB), anterior shear (AS) and axial rotation (AR). RESULTS Unilateral facetectomy increased native ROM in FE by 10.6% (7.6%-12.6%), in LS by 25.8% (18.7%-28.4%), in LB 7.5% (4.6%-12.7%), in AS 39.4% (22.6%-49.2%), and in AR by 27.2% (15.8%-38.6%). Interspinous vertebropexy significantly reduced ROM after unilateral facetectomy: in FE by 73% (p=.001), in LS by 23% (p=.001), in LB by 13% (p=.003), in AS by 16% (p=.007), and in AR by 20% (p=.001). In FE and LS the ROM was lower than in the baseline/native condition. In AS and AR, the baseline ROM was not reached by 17% and 1%, respectively. Spinolaminar vertebropexy significantly reduced ROM after unilateral facetectomy: in FE by 74% (p=.001), in LS by 24% (p=.001), in LB by 13% (p=.003), in AS by 28% (p=.004), and in AR by 15 % (p=.001). Baseline ROM was not reached by 9% in AR. CONCLUSION Interspinous vertebropexy seems to sufficiently counteract destabilization after unilateral total facetectomy, and limits range of motion in flexion and extension while avoiding full segmental immobilization. Spinolaminar vertebropexy additionally restores native anteroposterior stability, allowing satisfactory control of shear forces after facetectomy. CLINICAL SIGNIFICANCE Lumbar vertebropexy seems promising to counteract the destabilizating effect of facetectomy by targeted stabilization.
Collapse
Affiliation(s)
- Anna-Katharina Calek
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland; Spine Biomechanics, Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Lengghalde 5, CH-8008, Zurich, Switzerland.
| | - Jonas Widmer
- Spine Biomechanics, Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Lengghalde 5, CH-8008, Zurich, Switzerland
| | - Marie-Rosa Fasser
- Spine Biomechanics, Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Lengghalde 5, CH-8008, Zurich, Switzerland
| | - Mazda Farshad
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland; University Spine Center Zurich, Balgrist University Hospital, University of Zurich, Forchstrasse 340, CH-8008, Zurich, Switzerland
| |
Collapse
|
7
|
Farshad M, Fasser MR, Widmer J, Unterfrauner I, Schader JF, Calek AK. Vertebropexy as a Ligamentous Stabilization for Degenerative Low-Grade Spondylolisthesis: A Report of 3 Cases. JBJS Case Connect 2023; 13:01709767-202312000-00023. [PMID: 37917724 DOI: 10.2106/jbjs.cc.23.00413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
CASE Three patients with low-grade spondylolisthesis were treated with vertebropexy, a new surgical technique that replaces rigid fusion with ligamentous stabilization. Clinical outcomes, functional radiographs, and magnetic resonance imaging were used to document the early clinical results of this biomechanically established and promising new surgical method. CONCLUSION Vertebropexy may be a valuable alternative to rigid fusion in the treatment of low-grade degenerative spondylolisthesis.
Collapse
Affiliation(s)
- Mazda Farshad
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- University Spine Center Zürich, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Marie-Rosa Fasser
- Institute of Biomechanics, Balgrist Campus, ETH Zurich, Zurich, Switzerland
- Spine Biomechanics, Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Jonas Widmer
- Institute of Biomechanics, Balgrist Campus, ETH Zurich, Zurich, Switzerland
- Spine Biomechanics, Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Ines Unterfrauner
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- University Spine Center Zürich, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Jana Felicitas Schader
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Institute of Biomechanics, Balgrist Campus, ETH Zurich, Zurich, Switzerland
- Spine Biomechanics, Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Anna-Katharina Calek
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Spine Biomechanics, Department of Orthopedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| |
Collapse
|
8
|
Chang CC, Chang HK, Ko CC, Wu CL, Kuo YH, Tu TH, Huang WC, Wu JC. Comparison of Cortical Bone Trajectory to Pedicle-Based Dynamic Stabilization: An Analysis of 291 Patients. Neurospine 2023; 20:308-316. [PMID: 37016878 PMCID: PMC10080437 DOI: 10.14245/ns.2244888.444] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 12/20/2022] [Indexed: 04/03/2023] Open
Abstract
Objective: Pedicle-based dynamic stabilization (DS) has gained popularity outside of America. Although pedicle screw (PS) loosening has always been a concern, it is reportedly innocuous. Cortical bone trajectory (CBT) screw is an emerging option with less invasiveness and similar effectiveness to PS in short-segment lumbar fusion. This study aimed to verify the use of CBT for DS by comparing the outcomes between pedicle- and CBT-based DS.Methods: Consecutive patients with lumbar spondylosis or low-grade spondylolisthesis who underwent 1- or 2-level DS between L3–5 with a minimum follow-up of 24 months were reviewed. Screw loosening was determined by computed tomography and the incidences were compared.Results: A total of 291 patients who underwent Dynesys DS (235 pedicle- and 56 CBT-based, respectively) were compared. The demographics and preoperative conditions were similar. All the clinical outcomes improved at 24-month postoperation, while the CBT-based group had less operation time and blood loss than the pedicle-based group. The rates of screw loosening were lower in the CBT-based (5.4% per screw and 12.5% per patient) than the pedicle-based group (9% per screw and 26.4% per patient). Furthermore, there were no differences in the clinical outcomes and complication profiles.Conclusion: The CBT-based DS for 1- or 2-level lumbar degeneration demonstrated equivalent clinical improvement as the pedicle-based DS. The adaption of CBT-based screws for DS could be a less invasive approach (shorter operation time and less blood loss), with lower chances of screw loosening than the conventional PS-based DS.
Collapse
Affiliation(s)
- Chih-Chang Chang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- Department of BioMedical Engineering, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Hsuan-Kan Chang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Chin-Chu Ko
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Ching-Lan Wu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Hsuan Kuo
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Tsung-Hsi Tu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- Corresponding Author Tsung-Hsi Tu Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Room 525, 17F, No. 201, Shih-Pai Road, Sec. 2, Beitou, Taipei 11217, Taiwan
| | - Wen-Cheng Huang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Jau-Ching Wu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| |
Collapse
|
9
|
Xu YK, Weng PW, Chen SH, Lin SC. Biomechanical comparisons of dynamic fixators with rod-rod and screw-spacer joints on lumbar hybrid fixation. Clin Biomech (Bristol, Avon) 2023; 104:105943. [PMID: 37040676 DOI: 10.1016/j.clinbiomech.2023.105943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 04/13/2023]
Abstract
BACKGROUND Hybrid fixators with quite different joint design concepts have been widely to suppress adjacent segment degeneration problems. The kinematic and kinetic responses of the adjacent and transition segments and contact behaviors at the bone-screw interfaces served as the objective of this study. METHODS The moderately degenerated L4/L5 and mildly degenerative L3/L4 segments were respectively immobilized by a static fixator and further bridged by the rod-rod (Isobar) and screw-spacer (Dynesys) fixator. The joint stiffness and mobility of the rod-rod system and the cable pretension of the screw-spacer system were systematically varied. FINDINGS The flexion of the screw-spacer system provided higher mobility to the transition segment, reducing adjacent-segment problems. The cable pretension had a minor effect on the construct behavior. However, due to limited joint mobility, the rod-rod system showed higher constraints to the transition segment and induced more adjacent-segment compensations. The increased mobility of the rod-rod joint caused it to behave as a more dynamic fixator that increased adjacent-segment compensations at the transition segment. Comparatively, increasing the joint mobility showed more significant effects on the construct behaviors than decreasing the joint stiffness. Furthermore, increased constraint by the rod-rod joint induced higher stress and risk of loosening at the bone-screw interfaces INTERPRETATION: If the protection of the transition segment is the major concern, the rod-rod system can be used to constrain the intervertebral motion and share the higher loads through the fixator. Otherwise, the screw-spacer system is recommended in situations where higher loads onto the transition disc are allowable.
Collapse
Affiliation(s)
- Yu-Kun Xu
- Graduate Institute of Applied Science and Technology, National Taiwan University of Science and Technology, Taipei, Taiwan; Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan
| | - Pei-Wei Weng
- Department of Orthopedics, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan; International Ph.D. Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan; Department of Orthopaedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Research Center of Biomedical Device, Taipei Medical University, Taipei, Taiwan
| | - Shih-Hao Chen
- Tzu Chi General Hospital at Taichung and Tzu Chi University, Taiwan
| | - Shang-Chih Lin
- Graduate Institute of Biomedical Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan.
| |
Collapse
|
10
|
Biomechanical and clinical studies on lumbar spine fusion surgery: a review. Med Biol Eng Comput 2023; 61:617-634. [PMID: 36598676 DOI: 10.1007/s11517-022-02750-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 12/22/2022] [Indexed: 01/05/2023]
Abstract
Low back pain is associated with degenerative disc diseases of the spine. Surgical treatment includes fusion and non-fusion types. The gold standard is fusion surgery, wherein the affected vertebral segment is fused. The common complication of fusion surgery is adjacent segment degeneration (ASD). The ASD often leads to revision surgery, calling for a further fusion of adjacent segments. The existing designs of nonfusion type implants are associated with clinical problems such as subsidence, difficulty in implantation, and the requirement of revision surgeries. Various surgical approaches have been adopted by the surgeons to insert the spinal implants into the affected segment. Over the years, extensive biomechanical investigations have been reported on various surgical approaches and prostheses to predict the outcomes of lumbar spine implantations. Computer models have been proven to be very effective in identifying the best prosthesis and surgical procedure. The objective of the study was to review the literature on biomechanical studies for the treatment of lumbar spinal degenerative diseases. A critical review of the clinical and biomechanical studies on fusion spine surgeries was undertaken. The important modeling parameters, challenges, and limitations of the current studies were identified, showing the future research directions.
Collapse
|
11
|
Hsu FC, Chen CS, Yao YC, Lin HH, Wang ST, Chang MC, Liu CL, Chou PH. Shorter screw lengths in dynamic Dynesys fixation have less screw loosening: From clinical investigation to finite-element analysis. J Chin Med Assoc 2023; 86:330-337. [PMID: 36729417 DOI: 10.1097/jcma.0000000000000864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The dynamic Dynesys Stabilization System preserves lumbar mobility at instrumented levels. This study investigated the effect of screw length on screw loosening (SL) after dynamic Dynesys fixation and screw displacement during lumbar motion, using clinical investigation and finite-element (FE) analysis. METHODS Clinical data of 50 patients with degenerative spondylolisthesis treated with decompression and Dynesys fixation in 2011 were analyzed retrospectively. Horizontal sliding displacement and vertical displacement of screw tips at L4 were analyzed postoperatively using displacement-controlled FE analysis at the L4-L5 level with screw lengths 45 (long screw), 36 (median screw), and 27 (short screw), and 6.4 mm in diameter, under flexion, extension, lateral bending, and rotation. RESULTS In 13 patients (13/50, 26%), 40 screws (40/266, 15%) were loose at mean follow-up of 101.3 ± 4.4 months. Radiographic SL at 35, 40, 45, and 50 mm were 7.7%, 10.7%, 12.1%, and 37.5%, respectively, regardless of the fixation level ( p = 0.009). FE analysis revealed that the long screw model with corresponding longer lever arm had maximal horizontal sliding displacement under all directions and maximal vertical displacement, except for lateral bending. CONCLUSION Shorter screws in Dynesys fixation may help avoid dynamic SL. Clinically, 50 mm screws showed the greatest SL and median screw screws demonstrated the least displacement biomechanically.
Collapse
Affiliation(s)
- Fang-Chi Hsu
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chen-Sheng Chen
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yu-Cheng Yao
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Hsi-Hsien Lin
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shih-Tien Wang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ming-Chau Chang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chien-Lin Liu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Po-Hsin Chou
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| |
Collapse
|
12
|
Meco L, Finzi SS, Scoscina D, Amico S, Sirabella FS, Rotini M, Martiniani M, Specchia N, Gigante AP. Arthrodesis versus dynamic neutralization: A short/mid- and long-term retrospective evaluation in degenerative disk disease treatment. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2023; 14:59-64. [PMID: 37213572 PMCID: PMC10198210 DOI: 10.4103/jcvjs.jcvjs_159_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 02/04/2023] [Indexed: 03/14/2023] Open
Abstract
Study Design This was a retrospective comparative study. Objectives The aim of this study was to perform a clinical and radiological retrospective evaluation of the most used techniques for the lumbar degenerative disk disease (DDD) treatment: arthrodesis versus dynamic neutralization (DN)-Dynesys dynamic stabilization system. Methods The study included 58 consecutive patients affected by lumbar DDD, 28 treated with rigid stabilization and 30 with DN at our department between 2003 and 2013. The clinical evaluation was performed through the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI). The radiographic evaluation was performed through standard and dynamic X-ray projections and magnetic resonance imaging. Results Both techniques determined a clinical improvement in the postoperative period compared to the preoperative one. There were no significant differences between the postoperative VAS of the two techniques. The DN group postoperative ODI percentage showed a significant improvement (P = 0.026) compared to the arthrodesis group. During the follow-up, no clinically significant differences were highlighted between the two techniques. At a long term follow up period, radiographic results showed, in both groups, a L3-L4 disk mean height reduction and an increase of segmental and lumbar lordosis without significant differences between the two techniques. During an average of 96-month follow-up period, 5 (18%) patients developed an adjacent segment disease in the arthrodesis group and 6 (20%) patients developed this syndrome in the DN group. Conclusions We are confident in recommending arthrodesis and DN as effective techniques for lumbar DDD treatment. Both techniques are potentially burdened, with similar frequency, by the development of long-term adjacent segment disease.
Collapse
Affiliation(s)
- Leonard Meco
- Clinic of Adult and Paediatric Orthopaedics, Azienda Ospedaliero-Universitaria, Ospedali Riuniti Di Ancona, Ancona, Italy
| | - Simone Stefano Finzi
- Department of Clinical and Molecular Sciences, Università Politecnica Delle Marche, Ancona, Italy
| | - Dalila Scoscina
- Department of Clinical and Molecular Sciences, Università Politecnica Delle Marche, Ancona, Italy
| | - Silvia Amico
- Department of Clinical and Molecular Sciences, Università Politecnica Delle Marche, Ancona, Italy
| | | | - Marco Rotini
- Department of Clinical and Molecular Sciences, Università Politecnica Delle Marche, Ancona, Italy
| | - Monia Martiniani
- Clinic of Adult and Paediatric Orthopaedics, Azienda Ospedaliero-Universitaria, Ospedali Riuniti Di Ancona, Ancona, Italy
| | - Nicola Specchia
- Department of Clinical and Molecular Sciences, Università Politecnica Delle Marche, Ancona, Italy
| | - Antonio Pompilio Gigante
- Department of Clinical and Molecular Sciences, Università Politecnica Delle Marche, Ancona, Italy
| |
Collapse
|
13
|
Hsieh JY, Chen CS, Chuang SM, Wang JH, Chen PQ, Huang YY. Finite element analysis after rod fracture of the spinal hybrid elastic rod system. BMC Musculoskelet Disord 2022; 23:816. [PMID: 36008782 PMCID: PMC9413940 DOI: 10.1186/s12891-022-05768-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 08/14/2022] [Indexed: 11/18/2022] Open
Abstract
Background The spinal hybrid elastic (SHE) rod dynamic stabilization system can provide sufficient spine support and less adjacent segment stress. This study aimed to investigate the biomechanical effects after the internal fracture of SHE rods using finite element analysis. Methods A three-dimensional nonlinear finite element model was developed. The SHE rod comprises an inner nitinol stick (NS) and an outer polycarbonate urethane (PCU) shell (PS). The fracture was set at the caudal third portion of the NS, where the maximum stress occurred. The resultant intervertebral range of motion (ROM), intervertebral disc stress, facet joint contact force, screw stress, NS stress, and PCU stress were analyzed. Results When compared with the intact spine model, the overall trend was that the ROM, intervertebral disc stress, and facet joint force decreased in the implanted level and increased in the adjacent level. When compared with the Ns-I, the trend in the Ns-F decreased and remained nearly half effect. Except for torsion, the PS stress of the Ns-F increased because of the sharing of NS stress after the NS fracture. Conclusions The study concluded the biomechanical effects still afford nearly sufficient spine support and gentle adjacent segment stress after rod fracture in a worst-case scenario of the thinnest PS of the SHE rod system. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05768-x.
Collapse
Affiliation(s)
- Jui-Yang Hsieh
- Department of Biomedical Engineering, National Taiwan University, No. 7, Yulu Rd., Wuhu Village, Jinshan Dist., New Taipei City, 20844, Taiwan (R.O.C.).,Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan (R.O.C.).,Department of Orthopedic Surgery, National Taiwan University Hospital, Jinshan Branch, Taipei, Taiwan (R.O.C.)
| | - Chen-Sheng Chen
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan (R.O.C.)
| | - Shao-Ming Chuang
- Department of Physical Therapy and Assistive Technology, National Yang Ming Chiao Tung University, Taipei, Taiwan (R.O.C.)
| | - Jyh-Horng Wang
- Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan (R.O.C.)
| | - Po-Quang Chen
- Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan (R.O.C.)
| | - Yi-You Huang
- Department of Biomedical Engineering, National Taiwan University, No. 7, Yulu Rd., Wuhu Village, Jinshan Dist., New Taipei City, 20844, Taiwan (R.O.C.).
| |
Collapse
|
14
|
Biomechanical Comparison between Isobar and Dynamic-Transitional Optima (DTO) Hybrid Lumbar Fixators: A Lumbosacral Finite Element and Intersegmental Motion Analysis. BIOMED RESEARCH INTERNATIONAL 2022; 2022:8273853. [PMID: 35845942 PMCID: PMC9286886 DOI: 10.1155/2022/8273853] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/27/2022] [Indexed: 11/18/2022]
Abstract
Biomechanical performance of longitudinal component in dynamic hybrid devices was evaluated to display the load-transfer effects of Dynesys cord spacer or Isobar damper-joint dynamic stabilizer on junctional problem based on various disc degenerations. The dynamic component was adapted at the mildly degenerative L3–L4 segment, and the static component was fixed at the moderately degenerative L4–L5 segment under a displacement-controlled mode for the finite element study. Furthermore, an intersegmental motion behavior was analyzed experimentally on the synthetic model under a load-controlled mode. Isobar or DTO hybrid fixator could reduce stress/motion at transition segment, but compensation was affected at the cephalic adjacent segment more than the caudal one. Within the trade-off region (as a motion-preserving balance between the transition and adjacent segments), the stiffness-related problem was reduced mostly in flexion by a flexible Dynesys cord. In contrast, Isobar damper afforded the effect of maximal allowable displacement (more than peak axial stiffness) to reduce stress within the pedicle and at facet joint. Pedicle-screw travel at transition level was related to the extent of disc degeneration in Isobar damper-joint (more than Dynesys cord spacer) attributing to the design effect of axial displacement and angular rotation under motion. In biomechanical characteristics relevant to clinical use, longitudinal cord/damper of dynamic hybrid lumbar fixators should be designed with less interface stress occurring at the screw-vertebral junction and facet joint to decrease pedicle screw loosening/breakage under various disc degenerations.
Collapse
|
15
|
Xiao X, Chen G, Wang S, Liu J, Lin E, Chen K, Xiang Y, Zhan K, Liu C, Yuan Z, Yang M, Zhong S, Zhen W, Yang D, Peng S. Efficacy of the Dynesys Hybrid Surgery for Patients with Multi-Segmental Lumbar Spinal Stenosis. Front Surg 2022; 9:849679. [PMID: 35711699 PMCID: PMC9195297 DOI: 10.3389/fsurg.2022.849679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 04/18/2022] [Indexed: 11/13/2022] Open
Abstract
Objective The efficacy of hybrid (Dynesys and fusion) surgery and the traditional transforaminal lumbar interbody fusion surgery was compared in patients with multi-segmental lumbar spinal stenosis. Methods A total of 68 patients with multi-segmental lumbar spinal stenosis subjected to surgery were recruited between January 2013 and October 2020 in the First Affiliated Hospital of Southern University of Science and Technology. The patients were divided into a hybrid group (N = 33) and a TLIF group (N = 35) by surgery. After surgery, follow-up was conducted for 12 months. Between the two groups, the following parameters were compared: general conditions, clinical symptom scores, imaging parameters, and early complications. Results A statistically significant difference in the duration of surgery was noted between the two groups. After 12 months of follow-up, the range of motion disappeared in the TLIF group, while 63.53% was preserved in the hybrid group with statistically significant differences. A statistically significant difference was identified in the Oswestry Disability Index one week after surgery. Nonetheless, no statistically significant differences were observed at the 12-month post-surgical follow-up. Pfirrmann grade showed a 3.03% upper adjacent segment degeneration rate in the hybrid group (1/33) at 12-month follow-up and 2.86% (1/35) in the TLIF group. Notably, no early complications (screw loosening and wound infection) were identified in the two groups. Conclusion The Dynesys hybrid surgery combined the advantages of two systems of dynamic stabilization and rigid fusion. Besides, hybrid surgery is potentially a novel approach for the treatment of multi-segmental lumbar spinal stenosis.
Collapse
Affiliation(s)
- Xiao Xiao
- Department of Spine Surgery, The First Affiliated Hospital (Shenzhen People’s Hospital), Southern University of Science and Technology, Shenzhen, China
| | - Gaoyang Chen
- Department of Spine Surgery, The First Affiliated Hospital (Shenzhen People’s Hospital), Southern University of Science and Technology, Shenzhen, China
- Department of Spine, ShenzhenKey Laboratory of Reconstruction of Structure and Function in Sports System, Shenzhen, China
| | - Song Wang
- Department of Spine Surgery, The First Affiliated Hospital (Shenzhen People’s Hospital), Southern University of Science and Technology, Shenzhen, China
| | - Junliang Liu
- Department of Spine Surgery, The First Affiliated Hospital (Shenzhen People’s Hospital), Southern University of Science and Technology, Shenzhen, China
| | - Erhu Lin
- Department of Spine Surgery, The First Affiliated Hospital (Shenzhen People’s Hospital), Southern University of Science and Technology, Shenzhen, China
| | - Ke Chen
- Department of Spine Surgery, The First Affiliated Hospital (Shenzhen People’s Hospital), Southern University of Science and Technology, Shenzhen, China
| | - Yucheng Xiang
- Department of Spine Surgery, The First Affiliated Hospital (Shenzhen People’s Hospital), Southern University of Science and Technology, Shenzhen, China
| | - Ke Zhan
- Department of Spine Surgery, The First Affiliated Hospital (Shenzhen People’s Hospital), Southern University of Science and Technology, Shenzhen, China
| | - Congcong Liu
- Department of Spine Surgery, The First Affiliated Hospital (Shenzhen People’s Hospital), Southern University of Science and Technology, Shenzhen, China
| | - Zhengbin Yuan
- Department of Spine Surgery, The First Affiliated Hospital (Shenzhen People’s Hospital), Southern University of Science and Technology, Shenzhen, China
| | - Minjie Yang
- Department of Radiology, The First Affiliated Hospital (Shenzhen People’s Hospital), Southern University of Science and Technology, Shenzhen, China
| | - Shuyuan Zhong
- Department of Radiology, The First Affiliated Hospital (Shenzhen People’s Hospital), Southern University of Science and Technology, Shenzhen, China
| | - Wanxin Zhen
- Department of Spine Surgery, The First Affiliated Hospital (Shenzhen People’s Hospital), Southern University of Science and Technology, Shenzhen, China
| | - Dazhi Yang
- Department of Spine Surgery, The First Affiliated Hospital (Shenzhen People’s Hospital), Southern University of Science and Technology, Shenzhen, China
- Department of Spine, ShenzhenKey Laboratory of Reconstruction of Structure and Function in Sports System, Shenzhen, China
| | - Songlin Peng
- Department of Spine Surgery, The First Affiliated Hospital (Shenzhen People’s Hospital), Southern University of Science and Technology, Shenzhen, China
- Department of Spine, ShenzhenKey Laboratory of Reconstruction of Structure and Function in Sports System, Shenzhen, China
- Correspondence: Peng Songlin
| |
Collapse
|
16
|
Effect of Discectomy on Dynesys Dynamic Fixation in the Treatment of Lumbar Degenerative Diseases. Pain Res Manag 2022; 2021:3043645. [PMID: 35003407 PMCID: PMC8736702 DOI: 10.1155/2021/3043645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/09/2021] [Accepted: 12/15/2021] [Indexed: 11/18/2022]
Abstract
Objective To compare the effect of decompression of the spinal canal with or without discectomy on the clinical efficacy of Dynesys dynamic fixation treatment in lumbar degenerative diseases. Methods A total of 62 patients treated for single-segment lumbar degenerative disease from October 2010 to November 2017 were retrospectively analyzed. All patients underwent decompression of the spinal canal with Dynesys dynamic fixation and were divided into two groups. Twenty-seven patients in group A did not undergo discectomy, and 35 patients in group B underwent discectomy. The intervertebral height, range of motion, Pfirrmann grade of the surgical segment and the upper adjacent segment, function scores, and operation information were compared. Results All patients were followed up for an average of 30.7 ± 11.5 months. At the final follow-up, the intervertebral height and range of motion of the surgical segment decreased significantly in both group A and B (p < 0.05), the range of motion of the upper adjacent segment increased significantly (p < 0.05), and the intervertebral height did not change significantly (p < 0.05). The retained percentages of surgical segment intervertebral height and ROM in group A were significantly better than those in group B (p < 0.05). The intervertebral height (p > 0.05) and range of motion (p < 0.05) of the surgical segment in group A were higher than those in group B. The surgical segment Pfirrmann grading of group A was better than that of group B (p < 0.05). Conclusion Dynesys in the treatment of lumbar degenerative diseases may lead to a good clinical effect. In selected cases without discectomy, the range of motion and intervertebral height may be better preserved, and disc degeneration may be reduced.
Collapse
|
17
|
Khalifé M, Devriese F, Ferrero E, Zadegan F, Ajavon L, Mazel C. Dynesys® dynamic stabilization outcomes in degenerative spine surgery. Acta Orthop Belg 2021; 87:795-803. [PMID: 35172450 DOI: 10.52628/87.4.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Dynesys® is a dynamic device used for posterior stabilization of the lumbar spine. The objective of this study was to analyze the clinical and radiological outcomes at a 2-year minimum follow-up. In this retrospective study, patients operated between 2009 and 2016 with Dynesys® stabilization were included. 5 different etiologies were included: disc herniation, lumbar stenosis, revision for adjacent seg- ment disease (ASD), spondylolisthesis, and scoliosis. Clinical and radiological evaluations were performed. Postoperative complications and revisions were recorded. 136 patients were included: 34 for lumbar spinal stenosis, 19 for disc herniation, 29 degenerative spon- dylolisthesis, 41 revisions for ASD, and 13 scoliosis. Mean age was 64.8. Average clinical follow-up was 46 months. Postoperative clinical results showed a mean lumbar VAS of 3.07, a mean radicular VAS of 3.01 and an ODI score of 31.8%. The ASD rate was 16.2%, and overall revision rate was 11.8%. 2 cases (1.5%) of screw loosening were identified. Clinical outcomes, ASD rate and revision rate were more favorable in the spondylolisthesis and disc herniation groups. This study has one of the largest Dynesys® cohort in literature. Spinal dynamic stabilization by Dynesys® presents good long-term clinical and radiological out- comes with a lower rate of complications than pre- viously published cohorts and lumbar fusions. Best indications seem to be degenerative spondylolisthesis.
Collapse
|
18
|
Current concepts of spondylosis and posterior spinal motion preservation for radiologists. Skeletal Radiol 2021; 50:2169-2184. [PMID: 34131792 DOI: 10.1007/s00256-021-03840-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/03/2021] [Accepted: 06/03/2021] [Indexed: 02/02/2023]
Abstract
Spinal fusion is performed to eliminate motion at a degenerated or unstable segment. However, this is associated with loss of motion at the fused levels and increased stress on adjacent levels. Motion-preserving implants have been designed in effort to mitigate the limitations of fusion. This review will focus on posterior spinal motion-preserving technologies. In the cervical spine, laminoplasty is a posterior motion-preserving procedure used in the management of myelopathy/cord compression. In the lumbar spine, motion-sparing systems include interspinous process devices (also referred to as interspinous process spacers or distraction devices), posterior dynamic stabilization devices (also referred to as pedicle screw/rod fixation-based systems), and posterior element replacement systems (also referred to as total facet replacement devices). Knowledge of the intended physiologic purpose, hardware utilized, and complications is important in the assessment of imaging in those who have undergone posterior motion preservation procedures.
Collapse
|
19
|
Postoperative Management Strategy of Surgical Site Infection following Lumbar Dynesys Dynamic Internal Fixation. Pain Res Manag 2021; 2021:2262837. [PMID: 34659599 PMCID: PMC8516528 DOI: 10.1155/2021/2262837] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/22/2021] [Indexed: 11/18/2022]
Abstract
Aim To research the incidence of surgical site infection (SSI) following lumbar Dynesys dynamic internal fixation and its management strategy. Methods We retrospectively analyzed all cases of lumbar Dynesys dynamic internal fixation performed from January 2010 to December 2019, and the data from patients with SSI were collected. The observational indicators included the incidence of SSI, general information of the patients, surgical details, inflammatory indicators, pathogenic bacteria, and treatment. SSI was defined as both early infection and delayed infection, and the cases were divided into Groups A and B, respectively. The relevant indicators and treatment were compared between the two groups. Results A total of 1125 cases of lumbar Dynesys dynamic internal fixation were followed up. Twenty-five cases of SSI occurred, and the incidence of SSI was 2.22% (25/1125). There were 14 cases of early infection (1.24%) and 11 cases of delayed infection (0.98%). Fourteen cases of early infection occurred 12.3 ± 8.3 days postoperatively (3–30), and 11 cases of delayed infection occurred 33.3 ± 18.9 months postoperatively (3–62). The inflammatory indicators of Group A were significantly higher than those of Group B (all P < 0.05), except for procalcitonin. The main infection site in Group A was located on the skin and subcutaneous tissue and around the internal instrument, while the main infection site in Group B was around the internal instrument. The main treatment for Group A was debridement and implant replacement, and the main treatment for Group B was implant removal. Summary. The incidence of SSI following lumbar Dynesys dynamic internal fixation was 2.22%, the incidence of early SSI was 1.24%, and the incidence of delayed SSI was 0.98%. If the main infection site of early infection is in the incision, debridement should be the main treatment method; if the infection site is around the internal fixation, implant replacement is recommended on the basis of debridement. Once delayed infection is diagnosed, implant removal is suggested.
Collapse
|
20
|
Jung JM, Hyun SJ, Kim KJ, Jahng TA. Dynamic Stabilization Surgery in Patients with Spinal Stenosis: Long-term Outcomes and the Future. Spine (Phila Pa 1976) 2021; 46:E893-E900. [PMID: 33826593 DOI: 10.1097/brs.0000000000004049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES The purpose of this study was to analyze the long-term results for patients with lumbar spinal stenosis (LSS) treated with dynamic stabilization (DS) and to consider how we can improve the results. SUMMARY OF BACKGROUND DATA Few studies have reported long-term outcomes of DS surgery for LSS with or without spondylolisthesis. METHODS A single-center, single-surgeon consecutive series of LSS patients who underwent DS surgery with at least 5 years of follow-up were retrospectively reviewed. Twenty-seven patients were included in the LSS group and 38 patients in the spondylolisthesis group. Patient characteristics, operative data, radiographic parameters, clinical outcomes, and complications were analyzed at baseline and follow-up. RESULTS In the LSS group, all radiographic parameters (e.g., disc height, segmental lordosis, segmental range of motion [ROM] at the index level and proximal adjacent level, global lordosis, and global ROM) were maintained well until the last follow-up. In the spondylolisthesis group, global lordosis decreased from 36.5° ± 8.2° to 32.6° ± 6.0° at the last follow-up (P = 0.039), and global ROM decreased from 22.1° ± 6.9° to 18.8° ± 7.1° at the last follow-up (P = 0.012). In both groups, back pain, leg pain, and Oswestry Disability Index scores showed significant and sustained improvements. Screw loosening occurred in three patients (11.1%) in the LSS group and five patients (13.2%) in the spondylolisthesis group. Symptomatic adjacent segment degeneration (ASD) occurred in two patients (7.4%) in the LSS group and three patients (7.9%) in the spondylolisthesis group. CONCLUSION Decompression and DS surgery for LSS with or without spondylolisthesis showed favorable long-term surgical outcomes with an acceptable rate of complications and ASD. However, an improved physiological DS system should be developed.Level of Evidence: 4.
Collapse
Affiliation(s)
- Jong-Myung Jung
- Department of Neurosurgery, Spine Center, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Seung-Jae Hyun
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Ki-Jeong Kim
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Tae-Ahn Jahng
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| |
Collapse
|
21
|
Schauvliege H, Du Bois M, Verlooy J. Implant failure following pedicle based dynamic stabilization of the lumbar spine. Acta Orthop Belg 2021. [DOI: 10.52628/87.1.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Pedicle-based dynamic stabilization (PBDS) devices such as Dynesys are promoted as an alternative and less invasive option for rigid stabilization of one and even more levels of the lumbar spine. Promising features of the Dynesys system, as well as shortcomings, became obvious in several clinical studies. Since 2012, we started using a new PBDS device as an alternative for the Dynesys, to avoid the screw loosening and the kyphosing effect.
The objective is to compare failure rates between the Dynesys and Balan-C type PBDS implant and factors affecting outcome.
In a retrospective study we investigated a total of 90 patients with lumbar pedicle screw dynamic stabilization (a group of 64 patiënts with Dynesys stabilization is compared to a group of 26 patients with Balan-C stabilization). Mean follow-up was 48 and 38 months, respectively. Using logistic regression analysis the impact of baseline characteristics such as gender, age, body mass index (BMI), indication for surgery, primary or revision surgery, single versus more level surgery, surgeon’s experience and type of the implant on implant failure was analyzed.
We found a statistically significant difference in failure rates between the two systems (13% in the Dynesys group versus 62% in the Balan-C group). In multivariate analysis, type of implant was associated with implant failure (odds ratio : 13).
Our current results call for an optimization of the pre-and post-marketing surveillance of pedicle-based dynamic stabilization.
Collapse
|
22
|
Chou PH, Lin HH, Yao YC, Wang ST, Chang MC, Liu CL. Preoperative facet joint arthropathy does not impact long-term clinical outcomes after lumbar-stability-preserving decompression and dynesys fixation. Sci Rep 2021; 11:11299. [PMID: 34050251 PMCID: PMC8163830 DOI: 10.1038/s41598-021-90967-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 05/19/2021] [Indexed: 11/09/2022] Open
Abstract
To evaluate the impact of the preoperative severity of facet joint arthropathy on long-term functional outcomes and spinopelvic parameters in patients undergoing lumbar-stability-preserving decompression and Dynesys fixation. In this retrospective study, 88 patients undergoing combined surgery at our hospital from 2008 to 2015 were included. The patients were divided into two groups, the less and more than mean degeneration groups, based on preoperative facet joint arthropathy of the index level(s). The clinical outcomes were the Visual Analogue Scale (VAS) score, the Oswestry Disability Index (ODI) score and spinopelvic parameters. The mean follow-up durations for the less and more than mean degeneration groups were 84.83 ± 27.58 and 92.83 ± 20.45 months, respectively. The combined surgery significantly improved VAS and ODI scores, and increased sacral slope (SS) regardless of preoperative arthropathy severity. In addition, facet joint arthropathy at adjacent levels continued to worsen after surgery in both arthropathy severity groups. Preoperative facet joint arthropathy did not influence most long-term clinical outcomes in patients undergoing lumbar-stability-preserving decompression and Dynesys fixation. This combined surgery may be suitable for patients with facet joint arthropathy regardless of disease severity.
Collapse
Affiliation(s)
- Po-Hsin Chou
- School of Medicine, National Yang Ming Chiao Tung University, No.155, Sec.2, Linong Street, Beitou District, Taipei, 112, Taiwan, ROC. .,Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, 18F, 201, Section 2, Shipai Road, Beitou District, Taipei, 112, Taiwan, ROC.
| | - Hsi-Hsien Lin
- School of Medicine, National Yang Ming Chiao Tung University, No.155, Sec.2, Linong Street, Beitou District, Taipei, 112, Taiwan, ROC.,Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, 18F, 201, Section 2, Shipai Road, Beitou District, Taipei, 112, Taiwan, ROC
| | - Yu-Cheng Yao
- School of Medicine, National Yang Ming Chiao Tung University, No.155, Sec.2, Linong Street, Beitou District, Taipei, 112, Taiwan, ROC.,Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, 18F, 201, Section 2, Shipai Road, Beitou District, Taipei, 112, Taiwan, ROC
| | - Shih-Tien Wang
- School of Medicine, National Yang Ming Chiao Tung University, No.155, Sec.2, Linong Street, Beitou District, Taipei, 112, Taiwan, ROC.,Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, 18F, 201, Section 2, Shipai Road, Beitou District, Taipei, 112, Taiwan, ROC
| | - Ming-Chau Chang
- School of Medicine, National Yang Ming Chiao Tung University, No.155, Sec.2, Linong Street, Beitou District, Taipei, 112, Taiwan, ROC.,Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, 18F, 201, Section 2, Shipai Road, Beitou District, Taipei, 112, Taiwan, ROC
| | - Chien-Lin Liu
- School of Medicine, National Yang Ming Chiao Tung University, No.155, Sec.2, Linong Street, Beitou District, Taipei, 112, Taiwan, ROC.,Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, 18F, 201, Section 2, Shipai Road, Beitou District, Taipei, 112, Taiwan, ROC
| |
Collapse
|
23
|
Zhang X, Zhu J, Li Y, Hao D, Gao W. A modified method to treat severe asymptomatic pre-existing degeneration of adjacent segment: a retrospective case-control study. BMC Surg 2021; 21:161. [PMID: 33757478 PMCID: PMC7989102 DOI: 10.1186/s12893-021-01163-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 03/17/2021] [Indexed: 12/04/2022] Open
Abstract
Background Pre-existing degeneration of adjacent segment is an important risk factor for adjacent-segment degeneration (ASD), but only limited and controversial studies have addressed its management. Methods
We retrospectively analyzed patients with symptomatic degeneration of the L5/S1 segment warranting surgical interference and severe asymptomatic degeneration of the L4/5 segment. Of these patients, those who underwent interbody fusion of the causative (L5/S1) segment and distraction of the intervertebral space and facet fusion of the adjacent L4/5 segment were included in Group A (n = 103), while those who underwent interbody fusion of both the L5/S1 and L4/5 segments were included in Group B (n = 81). Clinical and radiographic outcomes were evaluated. Results Mean follow-up time was 58.5 months (range, 48–75 months). We found no significant difference in clinical outcomes or incidence of ASD in the L3/4 segment between Groups A and B. Compared with Group B, Group A experienced less bleeding (315 ± 84 ml vs. 532 ± 105 ml), shorter operation time (107 ± 34 min vs. 158 ± 55 min) and lower costs (US $13,830 ± $2640 vs. US $16,020 ± $3380; P < 0.05). In Group A, the disc height ratio (DHR) of the L4/5 segment was significantly increased from a preoperative value of 0.40 ± 0.13 to a last–follow-up value of 0.53 ± 0.18 (P < 0.05), while the degree of canal stenosis (DCS) was decreased from a preoperative value of 34.3 ± 11.2% to a last–follow-up value of 15.9 ± 9.3 % (P < 0.05). Conclusions This modified method could be effective in treating severe asymptomatic pre-existing degeneration of adjacent segment in the lumbar spine. Supplementary Information The online version contains supplementary material available at 10.1186/s12893-021-01163-w.
Collapse
Affiliation(s)
- Xinliang Zhang
- Department of Spine Surgery, Xi'an Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jinwen Zhu
- Department of Spine Surgery, Xi'an Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Yibing Li
- Department of Spine Surgery, Xi'an Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Dingjun Hao
- Department of Spine Surgery, Xi'an Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Wenjie Gao
- Department of Spine Surgery, Xi'an Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China.
| |
Collapse
|
24
|
Peng BG, Gao CH. Is Dynesys dynamic stabilization system superior to posterior lumbar fusion in the treatment of lumbar degenerative diseases? World J Clin Cases 2020; 8:5496-5500. [PMID: 33344539 PMCID: PMC7716310 DOI: 10.12998/wjcc.v8.i22.5496] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/19/2020] [Accepted: 10/20/2020] [Indexed: 02/05/2023] Open
Abstract
Dynesys, a pedicle-based dynamic stabilization system, was introduced to overcome some undesirable complications of fusion procedures. Nevertheless, the theoretical advantages of Dynesys over fusion have not been clearly confirmed. The purpose of this editorial was to compare clinical and radiological outcomes of patients who underwent Dynesys system with those who underwent posterior lumbar fusion according to the existing literature and to see if the application of the Dynesys system is superior to the traditional lumbar fusion surgery. According to published clinical reports, the short-term effects of the Dynesys dynamic stabilization system are similar to that of traditional lumbar fusion surgery. Three comparative studies of Dynesys dynamic stabilization and fusion surgery with medium-term follow-up are encouraging. However, the results from four single-treatment-arm and small-sample studies of case series with long-term follow-up were not encouraging. In the present circumstances, it is not possible to conclude that the Dynesys dynamic stabilization system is superior to fusion surgery for lumbar degenerative diseases.
Collapse
Affiliation(s)
- Bao-Gan Peng
- Department of Spinal Surgery, The Third Medical Center, People’s Liberation Army General Hospital, Beijing 100039, China
| | - Chun-Hua Gao
- Department of Spinal Surgery, The Third Medical Center, People’s Liberation Army General Hospital, Beijing 100039, China
| |
Collapse
|
25
|
Paez D, Sathekge MM, Douis H, Giammarile F, Fatima S, Dhal A, Puri SK, Erba PA, Lazzeri E, Ferrando R, Filho PA, Magboo VP, Morozova O, Núñez R, Pellet O, Mariani G. Comparison of MRI, [ 18F]FDG PET/CT, and 99mTc-UBI 29-41 scintigraphy for postoperative spondylodiscitis-a prospective multicenter study. Eur J Nucl Med Mol Imaging 2020; 48:1864-1875. [PMID: 33210240 PMCID: PMC8113215 DOI: 10.1007/s00259-020-05109-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 11/08/2020] [Indexed: 11/25/2022]
Abstract
Purpose Postoperative infection still constitutes an important complication of spine surgery, and the optimal imaging modality for diagnosing postoperative spine infection has not yet been established. The aim of this prospective multicenter study was to assess the diagnostic performance of three imaging modalities in patients with suspected postoperative spine infection: MRI, [18F]FDG PET/CT, and SPECT/CT with 99mTc-UBI 29-41. Methods Patients had to undergo at least 2 out of the 3 imaging modalities investigated. Sixty-three patients enrolled fulfilled such criteria and were included in the final analysis: 15 patients underwent all 3 imaging modalities, while 48 patients underwent at least 2 imaging modalities (MRI + PET/CT, MRI + SPECT/CT, or PET/CT + SPECT/CT). Final diagnosis of postoperative spinal infection was based either on biopsy or on follow-up for at least 6 months. The MRI, PET/CT, and SPECT/CT scans were read blindly by experts at designated core laboratories. Spine surgery included metallic implants in 46/63 patients (73%); postoperative spine infection was diagnosed in 30/63 patients (48%). Results Significant discriminants between infection and no infection included fever (P = 0.041), discharge at the wound site (P < 0.0001), and elevated CRP (P = 0.042). There was no difference in the frequency of infection between patients who underwent surgery involving spinal implants versus those who did not. The diagnostic performances of MRI and [18F]FDG PET/CT analyzed as independent groups were equivalent, with values of the area under the ROC curve equal to 0.78 (95% CI: 0.64–0.92) and 0.80 (95% CI: 0.64–0.98), respectively. SPECT/CT with 99mTc-UBI 29-41 yielded either unacceptably low sensitivity (44%) or unacceptably low specificity (41%) when adopting more or less stringent interpretation criteria. The best diagnostic performance was observed when combining the results of MRI with those of [18F]FDG PET/CT, with an area under the ROC curve equal to 0.938 (95% CI: 0.80–1.00). Conclusion [18F]FDG PET/CT and MRI both possess equally satisfactory diagnostic performance in patients with suspected postoperative spine infection, the best diagnostic performance being obtained by combining MRI with [18F]FDG PET/CT. The diagnostic performance of SPECT/CT with 99mTc-UBI 29-41 was suboptimal in the postoperative clinical setting explored with the present study. Supplementary Information The online version contains supplementary material available at 10.1007/s00259-020-05109-x.
Collapse
Affiliation(s)
- Diana Paez
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, International Atomic Energy Agency, PO Box 100, A-1400, Vienna, Austria
| | - Mike M Sathekge
- Nuclear Medicine Department, University of Pretoria & Steve Biko Academic Hospital, Pretoria, South Africa
| | - Hassan Douis
- University Hospital Birmigham, NHS Foundation Trust, Birmingham, UK
| | - Francesco Giammarile
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, International Atomic Energy Agency, PO Box 100, A-1400, Vienna, Austria.
| | - Shazia Fatima
- Department of Nuclear Medicine, Nuclear Medicine, Oncology & Radiotherapy Institute (NORI), Islamabad, Pakistan
| | - Anil Dhal
- Department of Orthopaedics, Maulana Azad Medical College, New Delhi, India
| | - Sunil K Puri
- Department of Radiology, GB Pant Hospital, Maulana Azad Medical College, New Delhi, India
| | - Paola A Erba
- Regional Centre of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Elena Lazzeri
- Regional Centre of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Rodolfo Ferrando
- Ferrari Ferrando-Paez Nuclear Medicine Clinic and Uruguayan Center of Molecular Imaging (CUDIM), Montevideo, Uruguay
| | | | | | - Olga Morozova
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, International Atomic Energy Agency, PO Box 100, A-1400, Vienna, Austria
| | - Rodolfo Núñez
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, International Atomic Energy Agency, PO Box 100, A-1400, Vienna, Austria
- Excel Diagnostics and Nuclear Oncology Center, Houston, TX, USA
| | - Olivier Pellet
- Nuclear Medicine and Diagnostic Imaging Section, Division of Human Health, International Atomic Energy Agency, PO Box 100, A-1400, Vienna, Austria
| | - Giuliano Mariani
- Regional Centre of Nuclear Medicine, Department of Translational Research and Advanced Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| |
Collapse
|
26
|
Kuo YH, Kuo CH, Chang HK, Tu TH, Fay LY, Chang CC, Cheng H, Wu CL, Lirng JF, Wu JC, Huang WC. Effects of smoking on pedicle screw-based dynamic stabilization: radiological and clinical evaluations of screw loosening in 306 patients. J Neurosurg Spine 2020; 33:398-405. [PMID: 32357328 DOI: 10.3171/2020.2.spine191380] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 02/21/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cigarette smoking has been known to increase the risk of pseudarthrosis in spinal fusion. However, there is a paucity of data on the effects of smoking in dynamic stabilization following lumbar spine surgery. This study aimed to investigate the clinical outcomes and the incidence of screw loosening among patients who smoked. METHODS Consecutive patients who had lumbar spondylosis, recurrent disc herniations, or low-grade spondylolisthesis that was treated with 1- or 2-level surgical decompression and pedicle screw-based Dynesys dynamic stabilization (DDS) were retrospectively reviewed. Patients who did not complete the minimum 2 years of radiological and clinical evaluations were excluded. All screw loosening was determined by both radiographs and CT scans. Patient-reported outcomes, including visual analog scale (VAS) scores of back and leg pain, Japanese Orthopaedic Association (JOA) scores, and Oswestry Disability Index (ODI), were analyzed. Patients were grouped by smoking versus nonsmoking, and loosening versus intact screws, respectively. All radiological and clinical outcomes were compared between the groups. RESULTS A total of 306 patients (140 women), with a mean age of 60.2 ± 12.5 years, were analyzed during an average follow-up of 44 months. There were 34 smokers (9 women) and 272 nonsmokers (131 women, 48.2% more than the 26.5% of smokers, p = 0.017). Postoperatively, all the clinical outcomes improved (e.g., VAS back and leg pain, JOA scores, and ODI, all p < 0.001). The overall rate of screw loosening was 23.2% (71 patients), and patients who had loosened screws were older (61.7 ± 9.6 years vs 59.8 ± 13.2 years, p = 0.003) and had higher rates of diabetes mellitus (33.8% vs 21.7%, p = 0.038) than those who had intact DDS screws. Although the patients who smoked had similar clinical improvement (even better VAS scores in their legs, p = 0.038) and a nonsignificantly lower rate of screw loosening (17.7% and 23.9%, p = 0.416), the chances of secondary surgery for adjacent segment disease (ASD) were higher than for the nonsmokers (11.8% vs 1.5%, p < 0.001). CONCLUSIONS Smoking had no adverse effects on the improvements of clinical outcomes in the pedicle screw-based DDS surgery. For smokers, the rate of screw loosening trended lower (without significance), but the chances of secondary surgery for ASD were higher than for the nonsmoking patients. However, the optimal surgical strategy to stabilize the lumbar spine of smoking patients requires future investigation.
Collapse
Affiliation(s)
- Yi-Hsuan Kuo
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine, National Yang-Ming University
| | - Chao-Hung Kuo
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine, National Yang-Ming University
- 3Department of Biomedical Engineering, School of Biomedical Science and Engineering, National Yang-Ming University
| | - Hsuan-Kan Chang
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine, National Yang-Ming University
- 4Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University
| | - Tsung-Hsi Tu
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine, National Yang-Ming University
- 6Taiwan International Graduate Program in Molecular Medicine, National Yang-Ming University and Academia Sinica; and
| | - Li-Yu Fay
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine, National Yang-Ming University
- 5Institute of Pharmacology, National Yang-Ming University
| | - Chih-Chang Chang
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine, National Yang-Ming University
| | - Henrich Cheng
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine, National Yang-Ming University
- 5Institute of Pharmacology, National Yang-Ming University
| | - Ching-Lan Wu
- 2School of Medicine, National Yang-Ming University
- 7Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jiing-Feng Lirng
- 2School of Medicine, National Yang-Ming University
- 7Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jau-Ching Wu
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine, National Yang-Ming University
| | - Wen-Cheng Huang
- 1Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital
- 2School of Medicine, National Yang-Ming University
| |
Collapse
|
27
|
Wang H, Peng J, Zeng Q, Zhong Y, Xiao C, Ye Y, Huang W, Liu W, Luo J. Dynesys system vs posterior decompression and fusion for the treatment of lumbar degenerative diseases. Medicine (Baltimore) 2020; 99:e19784. [PMID: 32481251 PMCID: PMC7249866 DOI: 10.1097/md.0000000000019784] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The Dynesys dynamic stabilization system is an alternative to rigid instrumentation and fusion for the treatment of lumbar degenerative disease. The purpose of this study is to evaluate the clinical efficacy between Dynesys and posterior decompression and fusion for lumbar degenerative diseases. METHODS The computer was used to retrieve the Cochrane library, Medline, Embase, CNKI, Wanfang database and Chinese biomedical literature database; and the references and main Chinese and English Department of orthopedics journals were manually searched. All the prospective or retrospective comparative studies on the clinical efficacy and safety of Dynesys and posterior decompression and fusion were collected, so as to evaluate the methodological quality of the study and to extract the data. The RevMan 5.2 software was used for data analysis. RESULTS A total of 17 studies were included in the meta-analysis. There were no significant differences in Oswestry disability index and visual analogue score for leg pain, visual analogue score for back pain, L2-S1 ROM between Dynesys and fusion group. Operation time, blood loss, length of stay and complications in the Dynesys group were significantly less than that in the fusion group. Adjacent-segment degeneration in the fusion group was significantly higher than that in the Dynesys group. In addition, postoperative operated segment ROM was significantly less in the fusion group as compared to the Dynesys group. CONCLUSIONS Our meta-analysis suggests that Dynesys system acquires comparable clinical outcomes compared to fusion in the treatment of lumbar degenerative diseases. Moreover, compared with fusion, Dynesys could remain ROM of surgical segments with less operation time, blood loss, length of stay, adjacent-segment degeneration, and lower complication. Further studies with large samples, long term follow up and well-designed are needed to assess the two procedures in the future.
Collapse
Affiliation(s)
- Hongbo Wang
- Department of Spine Surgery, Shenzhen Baoan Shajing People's Hospital, Guangzhou Medical University, Shenzhen
| | - Jun Peng
- Department of Spine Surgery, Shenzhen Baoan Shajing People's Hospital, Guangzhou Medical University, Shenzhen
| | - Qingshen Zeng
- Department of Spine Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, PR China
| | - Yanchun Zhong
- Department of Spine Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, PR China
| | - Chunlin Xiao
- Department of Spine Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, PR China
| | - Yongjun Ye
- Department of Spine Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, PR China
| | - Weimin Huang
- Department of Spine Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, PR China
| | - Wuyang Liu
- Department of Spine Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, PR China
| | - Jiaquan Luo
- Department of Spine Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, PR China
| |
Collapse
|
28
|
Cecchinato R, Bourghli A, Obeid I. Revision surgery of spinal dynamic implants: a literature review and algorithm proposal. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:57-65. [PMID: 31916002 DOI: 10.1007/s00586-019-06282-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 12/14/2019] [Accepted: 12/29/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Dynamic stabilization of the spine has been performed since the 1990s with the double purpose of restoring spinal segmental stability and allowing residual movement at the operated level. When we take into account the different motion-preserving devices and the spinal areas where they are applied, we can identify three categories of spinal implants: anterior cervical, anterior lumbar, and posterior lumbar. However, as in all prosthetic procedures performed in orthopedic surgery, the life span of a joint replacement device is a central topic of discussion, and this is true also for spinal dynamic devices, being revision surgery a complex procedure in specific cases. MATERIALS AND METHODS We performed a literature review on the different dynamic spinal implants and the most common causes of failure, providing clinical cases as illustrative options for revision surgery. RESULTS The review of the literature showed a 11.3% to 22.6% revision rate in posterior lumbar dynamic systems, with a peak of 40.6% in case of adjacent segment disease. In lumbar TDRs, infection and severe dislocations are the most frequent causes of anterior revisions, while posterior pedicle screw fixation could be a suitable option in minimal subsidence or TDR displacement. An algorithm for the planning of revision surgery is proposed. CONCLUSIONS Surgical revision of spinal dynamic implants could be a demanding surgery especially in anterior approaches. Anterior cervical revision remains globally safe, but careful preoperative evaluation of vessels and ureter are suggested to avoid intraoperative complications in the lumbar spine. In posterior revision, a proper sagittal alignment of the spine should be restored. These slides can be retrieved under Electronic Supplementary Material.
Collapse
Affiliation(s)
- R Cecchinato
- GSpine4, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
| | - A Bourghli
- Orthopedic and Spinal Surgery Department, Kingdom Hospital, Riyadh, Saudi Arabia
| | - I Obeid
- Orthopedic Spinal Surgery Unit 1, Pellegrin Hospital, Place Amélie Raba-Léon, 33076, Bordeaux Cedex, France
| |
Collapse
|
29
|
Hu A, Sun C, Liang Y, Wang H, Li X, Dong J. Multi-segmental lumbar spinal stenosis treated with Dynesys stabilization versus lumbar fusion in elderly patients: a retrospective study with a minimum of 5 years' follow-up. Arch Orthop Trauma Surg 2019; 139:1361-1368. [PMID: 31289844 DOI: 10.1007/s00402-019-03234-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Middle- and long-term outcomes of multi-segmental lumbar spinal stenosis treated with Dynesys stabilization (DS) have rarely been reported. Older age and multi-segmental degeneration may be positive factors in achieving satisfactory outcomes following DS. The present study aimed to compare the middle- and long-term outcomes of DS with lumbar fusion for treatment of multi-segmental lumbar spinal stenosis (ms-LSS) in elderly patients. MATERIALS AND METHODS This study retrospectively analyzed patients with ms-LSS treated by DS or lumbar fusion from January 2011 to April 2013. Twenty-two patients were included in the Dynesys group, and 44 patients treated by lumbar fusion and rigid fixation were included in the fusion group. Clinical outcomes were assessed by VAS and ODI. Radiological outcomes were measured by range of motion (ROM) of stabilized segments and the proximal adjacent segment, intervertebral disc height (DH) and L1-S1 lumbar lordosis angle (LL). Modified Pfirrmann grade score was used to access disc degeneration. OUTCOMES The mean follow-up time of the Dynesys group and fusion group was 68.50 ± 6.40 and 70.14 ± 7.26 months, respectively. Baseline data were similar between the two groups. There were no significant differences between the two groups in terms of improvement of clinical outcomes (VAS and ODI). DS preserved a certain degree of ROM (3.74 ± 2.00) of surgical segments. ROM of proximal adjacent segment underwent an increase in both groups at the final follow-up. The DH of the surgical segments and proximal adjacent segment in both groups was significantly lower than that before surgery (P = 0.000). LL of both groups improved (P = 0.000), and there was no significant difference between the two groups. The modified Pfirrmann score of proximal adjacent segment of both groups increased at the final follow-up. The fusion group underwent a more significant increase (P = 0.000), whereas the inter-group difference showed no significance (P = 0.090). CONCLUSION DS is a safe and effective surgical treatment of multi-segmental lumbar spinal stenosis in the elderly population. DS preserves a certain degree of mobility of surgical segments.
Collapse
Affiliation(s)
- Annan Hu
- Department of Orthopeadic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Chi Sun
- Department of Orthopeadic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Yun Liang
- Department of Orthopeadic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Houlei Wang
- Department of Orthopeadic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China
| | - Xilei Li
- Department of Orthopeadic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China.
| | - Jian Dong
- Department of Orthopeadic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People's Republic of China.
| |
Collapse
|
30
|
Zhang Y, Zhang ZC, Li F, Sun TS, Shan JL, Guan K, Zhao GM, Zhang LZ. Long-Term Outcome of Dynesys Dynamic Stabilization for Lumbar Spinal Stenosis. Chin Med J (Engl) 2019; 131:2537-2543. [PMID: 30381586 PMCID: PMC6213831 DOI: 10.4103/0366-6999.244107] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background: Many clinical studies over the past decade have indicated positive outcomes for patients treated with Dynesys dynamic stabilization for lumbar degenerative disease. However, long-term outcomes of Dynesys for lumbar spinal stenosis are rarely reported. The aim of this study was to analyze the long-term clinical and radiologic outcomes for patients with lumbar spinal stenosis treated with Dynesys stabilization. Methods: Thirty-eight patients with lumbar spinal stenosis were treated with Dynesys stabilization from July 2008 to March 2010. The minimal duration of follow-up was 72 months. The patients were divided into stenosis and spondylolisthesis groups according to degenerative spondylolisthesis. Clinical outcomes were evaluated using the Oswestry Disability Index (ODI) and visual analog scale (VAS). Radiographic evaluations included range of motion (ROM) and the disc heights of stabilized segments and the upper adjacent segments. We also evaluated the occurrence of radiographic and symptomatic adjacent segment degeneration (ASD). Results: There were 23 patients in stenosis group and 15 patients in spondylolisthesis group. The ODI scores were significantly improved at the final follow-up evaluation, as compared to the baseline values (16.1 ± 5.7 vs. 57. 2 ± 14.2, t = 61.41, P < 0.01). The VAS scores for back and leg pain were significantly improved from 4.82 ± 0.89 and 4.04 ± 0.82 preoperatively to 0.93 ± 0.61 and 0.54 ± 0.51 postoperatively (t = 6.59, P < 0.01, and t = 5.91, P < 0.01, respectively). There were no differences between the two groups with respect to VAS and ODI scores. The ROM of stabilized segments decreased significantly from 7.8° ± 2.4° to 4.5° ± 1.5° (t = 7.18, P < 0.05), while the upper adjacent segments increased significantly from 8.3° ± 2.4° to 10.4° ± 2.4° (t = 2.87, P = 0.01). The change in disc height of stabilized segments was not significant (11.9 ± 2.1 preoperatively vs. 12.5 ± 1.5 postoperatively, t = 1.43, P = 0.15), whereas the decrease in disc height of the upper adjacent segments was significant (12.5 ± 2.0 preoperatively vs. 11.0 ± 1.7 postoperatively, t = 2.94, P = 0.01). The occurrence of radiographic and symptomatic ASD was 16% (6/38) and 3% (1/38), respectively. Conclusions: Decompression and Dynesys stabilization for lumbar stenosis with or without spondylolisthesis showed good long-term clinical and radiographic results. Lumbar stenosis with or without Grade I spondylolisthesis, particularly in patients <60 years of age with mild-to-moderate lumbar disc degeneration, would be one of the main indications for the Dynesys system.
Collapse
Affiliation(s)
- Yang Zhang
- Medical School of Chinese People's Liberation Army, Beijing 100853; Department of Orthopedics, Army General Hospital of Chinese People's Liberation Army, Beijing 100700, China
| | - Zhi-Cheng Zhang
- Department of Orthopedics, Army General Hospital of Chinese People's Liberation Army, Beijing 100700, China
| | - Fang Li
- Department of Orthopedics, Army General Hospital of Chinese People's Liberation Army, Beijing 100700, China
| | - Tian-Sheng Sun
- Medical School of Chinese People's Liberation Army, Beijing 100853; Department of Orthopedics, Army General Hospital of Chinese People's Liberation Army, Beijing 100700, China
| | - Jian-Lin Shan
- Department of Orthopedics, Army General Hospital of Chinese People's Liberation Army, Beijing 100700, China
| | - Kai Guan
- Department of Orthopedics, Army General Hospital of Chinese People's Liberation Army, Beijing 100700, China
| | - Guang-Min Zhao
- Department of Orthopedics, Army General Hospital of Chinese People's Liberation Army, Beijing 100700, China
| | - Li-Zhi Zhang
- Department of Orthopedics, Army General Hospital of Chinese People's Liberation Army, Beijing 100700, China
| |
Collapse
|
31
|
High Infection Rates in Patients with Long-Segment Dynesys System. World Neurosurg 2018; 119:e403-e406. [PMID: 30071334 DOI: 10.1016/j.wneu.2018.07.175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 07/19/2018] [Accepted: 07/21/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Infection follow-up in patients stabilized with the Dynesys system. Infection rates were determined in patients who had ≥5 segments stabilized with the Dynesys system. METHODS Eighty-three patients with various etiologies were stabilized with the Dynesys system. Long-level stabilization patients were separated from the main group as a result of their high rates of infection. RESULTS Long-level stabilizations were performed in 8 of 83 patients. Five patients were determined to have infections including 4 deep infections and 1 superficial infection. In patients with deep infections, 3 of them exhibited chronic infections that lasted for approximately 2 years and the system was removed. A deep infection in 1 patient and a superficial infection in 1 patient were diagnosed after 1 month. The early-diagnosed deep infection patient was treated with wound irrigation and antibiotics. The system was not removed, and the wound was closed with daily dressing after 45 days. One superficial infection patient was only treated with daily dressing, and the infection healed within 2 weeks. The infectious agent was determined in 2 patients. Three patients in the chronic infection group underwent a surgical procedure to remove the system. Specific antibiotic treatments were administered to patients whose infectious agents were identified. The remaining patients were treated with wide-spectrum antibiotics. CONCLUSIONS We report that long-level stabilization with the Dynesys system results in a high infection rate.
Collapse
|
32
|
Wu H, Pang Q, Jiang G. Medium-term effects of Dynesys dynamic stabilization versus posterior lumbar interbody fusion for treatment of multisegmental lumbar degenerative disease. J Int Med Res 2017; 45:1562-1573. [PMID: 28661265 PMCID: PMC5718723 DOI: 10.1177/0300060517708104] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Objective To compare the medium-term clinical and radiographic outcomes of Dynesys dynamic stabilization and posterior lumbar interbody fusion (PLIF) for treatment of multisegmental lumbar degenerative disease. Methods Fifty-seven patients with multisegmental lumbar degenerative disease underwent Dynesys stabilization (n = 26) or PLIF (n = 31) from December 2008 to February 2010. The mean follow-up period was 50.3 (range, 46–65) months. Clinical outcomes were evaluated using a visual analogue scale (VAS) and the Oswestry disability index (ODI). Radiographic evaluations included disc height and range of motion (ROM) of the operative segments and proximal adjacent segment on lumbar flexion-extension X-rays. The intervertebral disc signal change was defined by magnetic resonance imaging, and disc degeneration was classified by the Pfirrmann grade. Results The clinical outcomes including the VAS score and ODI were significantly improved in both groups at 3 months and the final follow-up, but the difference between the two was not significant. At the final follow-up, the disc height of stabilized segments in both groups was significantly increased; the increase was more notable in the Dynesys than PLIF group. The ROM of stabilized segments at the final follow-up decreased from 6.20° to 2.76° and 6.56° to 0.00° in the Dynesys and PLIF groups, respectively. There was no distinct change in the height of the proximal adjacent segment in the two groups. The ROM of the proximal adjacent segment in both groups increased significantly at the final follow-up; the change was significantly greater in the PLIF than Dynesys group. Only one case of adjacent segment degeneration occurred in the PLIF group, and this patient underwent a second operation. Conclusions Both Dynesys stabilization and PLIF can improve the clinical and radiographic outcomes of multisegmental lumbar degenerative disease. Compared with PLIF, Dynesys stabilization can maintain the mobility of the stabilized segments with less influence on the proximal adjacent segment and may help to prevent the occurrence of adjacent segment degeneration. Dynesys is reliable for the treatment of multisegmental lumbar degenerative disease at the medium-term follow-up.
Collapse
Affiliation(s)
- Haiting Wu
- 1 Department of Orthopaedics Center, Ningbo No. 2 Hospital, Ningbo, Zhejiang, China
| | - Qingjiang Pang
- 1 Department of Orthopaedics Center, Ningbo No. 2 Hospital, Ningbo, Zhejiang, China
| | - Guoqiang Jiang
- 2 Department of Spinal Surgery, The Affiliated Hospital of School of Medicine of Ningbo University, Ningbo, Zhejiang, China
| |
Collapse
|
33
|
Liao E, Srinivasan A. Applications of Dual-Energy Computed Tomography for Artifact Reduction in the Head, Neck, and Spine. Neuroimaging Clin N Am 2017; 27:489-497. [PMID: 28711208 DOI: 10.1016/j.nic.2017.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Conventional computed tomography (CT) uses a polychromatic energy beam to offer superb anatomic detail of the head and spine. However, technical challenges remain that can degrade the diagnostic image quality of these examinations. Dual-energy CT analyzes the changes in attenuation of soft tissues at different energy levels, from which different reconstructions can be made to yield the optimal contrast-to-noise ratio, reduce beam-hardening artifact, or evaluate tissue composition. In this article, selective applications of the dual energy CT technique are discussed, highlighting a powerful tool in the diagnostic CT evaluation of the head, neck, and spine.
Collapse
Affiliation(s)
- Eric Liao
- Division of Neuroradiology, Department of Radiology, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Ashok Srinivasan
- Division of Neuroradiology, Department of Radiology, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
| |
Collapse
|
34
|
Kashkoush A, Agarwal N, Paschel E, Goldschmidt E, Gerszten PC. Evaluation of a Hybrid Dynamic Stabilization and Fusion System in the Lumbar Spine: A 10 Year Experience. Cureus 2016; 8:e637. [PMID: 27433416 PMCID: PMC4938630 DOI: 10.7759/cureus.637] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION The development of adjacent-segment disease is a recognized consequence of lumbar fusion surgery. Posterior dynamic stabilization, or motion preservation, techniques have been developed which theoretically decrease stress on adjacent segments following fusion. This study presents the experience of using a hybrid dynamic stabilization and fusion construct for degenerative lumbar spine pathology in place of rigid arthrodesis. METHODS A clinical cohort investigation was conducted of 66 consecutive patients (31 female, 35 male; mean age: 53 years, range: 25 - 76 years) who underwent posterior lumbar instrumentation with the Dynesys Transition Optima (DTO) implant (Zimmer-Biomet Spine, Warsaw, IN) hybrid dynamic stabilization and fusion system over a 10-year period. The median length of follow-up was five years. DTO consists of pedicle screw fixation coupled to a rigid rod as well as a flexible longitudinal connecting system. All patients had symptoms of back pain and neurogenic claudication refractory to non-surgical treatment. Patients underwent lumbar arthrodesis surgery in which the hybrid system was used for stabilization instead of arthrodesis of the stenotic adjacent level. RESULTS Indications for DTO instrumentation were primary degenerative disc disease (n = 52) and failed back surgery syndrome (n = 14). The most common dynamically stabilized and fused segments were L3-L4 (n = 37) and L5-S1 (n = 33), respectively. Thirty-eight patients (56%) underwent decompression at the dynamically stabilized level, and 57 patients (86%) had an interbody device placed at the level of arthrodesis. Complications during the follow-up period included a single case of screw breakage and a single case of pseudoarthrosis. Ten patients (15%) subsequently underwent conversion of the dynamic stabilization portion of their DTO instrumentation to rigid spinal arthrodesis. CONCLUSION The DTO system represents a novel hybrid dynamic stabilization and fusion construct. This 10-year experience found the device to be highly effective as well as safe. The technique may serve as an alternative to multilevel arthrodesis. Implantation of a motion-preserving dynamic stabilization device immediately adjacent to a fused level instead of extending a rigid construct may reduce the subsequent development of adjacent-segment disease in this patient population.
Collapse
Affiliation(s)
- Ahmed Kashkoush
- Department of Neurological Surgery, University of Pittsburgh Medical Center
| | - Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh Medical Center
| | - Erin Paschel
- Department of Neurological Surgery, University of Pittsburgh Medical Center
| | | | - Peter C Gerszten
- Department of Neurological Surgery, University of Pittsburgh Medical Center
| |
Collapse
|
35
|
Hsieh CT, Chang CJ, Su IC, Lin LY. Clinical experiences of dynamic stabilizers: Dynesys and Dynesys top loading system for lumbar spine degenerative disease. Kaohsiung J Med Sci 2016; 32:207-15. [PMID: 27185604 DOI: 10.1016/j.kjms.2016.03.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 03/09/2016] [Accepted: 03/21/2016] [Indexed: 12/16/2022] Open
Abstract
Dynesys (Dynamic Neutralization System) was designed to overcome the shortcomings of fusion. The Dynesys top loading (DTL) system is a new alternative Dynesys system that can be applied via a minimally invasive procedure. This study aimed to ascertain whether DTL is a suitable device for motion preservation and prevention of instability, and to compare the clinical and radiological outcomes between DTL and Dynesys. In this study, 12 patients were treated with Dynesys and 21 patients were treated with DTL. Back and leg pain were evaluated using the visual analog scale. The Oswestry Disability Index was used to evaluate the patients' function. Range of motion (ROM) at the operative level and for the whole lumbar spine was measured pre- and postoperatively. The length of wound, blood loss, length of hospital stay, and operation duration were also compared. All patients were followed up for 12-76 months. Scores on the visual analog scale and Oswestry Disability Index were significantly improved postoperatively. The median ROM of the whole spine and index level ROM in all patients showed 12.5% and 79.6% loss, respectively. The DTL group exhibited significantly better results in terms of blood loss, wound length, and operation duration, in addition to early ambulation. In conclusion, Dynesys and DTL are semirigid fixation systems that can significantly improve clinical symptoms and signs. Our results suggested that DTL was better than Dynesys as a result of it being a minimally invasive procedure. However, further study with large sample sizes and longer follow-up durations is required to validate the effects of these dynamic stabilizers.
Collapse
Affiliation(s)
- Cheng-Ta Hsieh
- Department of Neurosurgery, Cathay General Hospital, Taipei City, Taiwan; Department of Medicine, School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Chih-Ju Chang
- Department of Neurosurgery, Cathay General Hospital, Taipei City, Taiwan; Department of Medicine, School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
| | - I-Chang Su
- Department of Neurosurgery, Cathay General Hospital, Taipei City, Taiwan; Department of Medicine, School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Li-Ying Lin
- Department of Surgery, Cathay General Hospital, Taipei City, Taiwan
| |
Collapse
|