Received:30 December 2016,
Published:15 June 2017
移动端阅览
Liyuan Wang, Chengmin Zhang, Lei Luo, et al. Clinical efficacy of Dynesys dynamic stabilization system for multi-segment lumbar degenerative disease: a report based on 2-year follow-up[J]. Journal of Third Military Medical University, 2017, 39(11): 1165-1170.
Liyuan Wang, Chengmin Zhang, Lei Luo, et al. Clinical efficacy of Dynesys dynamic stabilization system for multi-segment lumbar degenerative disease: a report based on 2-year follow-up[J]. Journal of Third Military Medical University, 2017, 39(11): 1165-1170. DOI: 10.16016/j.1000-5404.201612210.
Objective
2
To evaluate the clinical efficacy and lumbar motion function of Dynesys dynamic stabilization system and fusion in the treatment of lumbar multi-segment degenerative diseases by comparative analysis.
Methods
2
A total of 51 patients undergoing surgery for multi-segment stabilization and fusion in our hospital from January 2013 to May 2014 were enrolled in this study. There were 24 patients undergoing Dynesys dynamic stabilization and 27 fusion. Visual ananalogue scale (VAS) was used to measure the low back pain
and Oswestry disability index (ODI) was employed to assess the function of lumbar vertebra. Lumbar motion function was evaluated by comparing the range of motion (ROM) of whole lumbar spine and surgical segments
ROM of the upper adjacent segments
height of the upper adjacent segments
the incidence of adjacent segment disease (ASD) between the 2 groups of patients preoperatively and in 6
12 and 24 months postoperatively.
Results
2
All the patients were followed up for an average time of 26.2 (23~31) months (
P
<
0.05). The VAS scores and the ODI scores were significantly improved in the 2 groups at all the postoperative time points (
P
<
0.05). There were significant differences in the scores between the 2 groups in 6 month postoperatively (
P
<
0.05)
but no such difference at other time points. The Dynesys dynamic stabilization group retained more degrees of motion than the fusion group (
P
<
0.01)
and some of the surgical segment activity
but the fusion group lost the activity due to fusion (
P
<
0.01). Significant difference was seen in the ROM of the upper adjacent segments between the 2 groups
in 24 months postoperatively (
P
<
0.01)
but no difference was observed in the mean height of the intervertebral space between the 2 groups and at each time point. In ASD
3 cases of fusion group showed instability of upper adjacent segments
but without obvious clinical symptoms
and no clinical intervention was carried out.
Conclusion
2
Dynesys dynamic stabilization system shows a good clinical outcome
retains more activity
and reduces the occurrence of ASD in the treatment of lumbar multi-level degenerative disease. So it should be used as a better surgical option.
Zeng Z Y Wu P Sun D T Two different fixation methods combined with lumbar interbody fusion for the treatment of two-level lumbar vertebra diseases: a clinical comparison study Zhongguo Gu Shang 2015 28 10 903 909 Zeng Z Y, Wu P, Sun D T, et al .Two different fixation methods combined with lumbar interbody fusion for the treatment of two-level lumbar vertebra diseases: a clinical comparison study[J ] .Zhongguo Gu Shang, 2015, 28(10):903-909.
Stoffel M Behr M Reinke A Pedicle screw-based dynamic stabilization of the thoracolumbar spine with the Cosmic-system: a prospective observation Acta Neurochir(Wien) 2010 152 5 835 843 10.1007/s00701-009-0583-z Stoffel M, Behr M, Reinke A, et al .Pedicle screw-based dynamic stabilization of the thoracolumbar spine with the Cosmic-system: a prospective observation[J ] .Acta Neurochir(Wien), 2010, 152(5):835-843.DOI:10.1007/s00701-009-0583-z.
Ghiselli G Wang J C Bhatia N N Adjacent segment degeneration in the lumbar spine J Bone Joint Surg Am 2004 86-A 7 1497 1503 http://d.scholar.cnki.net/detail/SJPD0006_U/SJPD12090101722717 Ghiselli G, Wang J C, Bhatia N N, et al .Adjacent segment degeneration in the lumbar spine[J ] .J Bone Joint Surg Am, 2004, 86-A(7):1497-1503.
Zhang Y Shan J L Liu X M Comparison of the Dynesys Dynamic Stabilization System and Posterior Lumbar Interbody Fusion for Lumbar Degenerative Disease PLoS One 2016 11 1 e0148071 10.1371/journal.pone.0148071 Zhang Y, Shan J L, Liu X M, et al .Comparison of the Dynesys Dynamic Stabilization System and Posterior Lumbar Interbody Fusion for Lumbar Degenerative Disease[J ] .PLoS One, 2016, 11(1):e0148071.DOI:10.1371/journal.pone.0148071.
Mobbs R J Phan K Malham G Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF/ATP, LLIF and ALIF J Spine Surg 2015 1 1 2 18 10.3978/j.issn.2414-469X.2015.10.05 Mobbs R J, Phan K, Malham G, et al .Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF/ATP, LLIF and ALIF[J ] .J Spine Surg, 2015, 1(1): 2-18.DOI:10.3978/j.issn.2414-469X.2015.10.05.
Lazennec J Y Pouzet B Ramare S Anatomic basis of minimal anterior extraperitoneal approach to the lumbar spine Surg Radiol Anat 1999 21 1 7 15 10.1007/BF01635046 Lazennec J Y, Pouzet B, Ramare S, et al .Anatomic basis of minimal anterior extraperitoneal approach to the lumbar spine[J ] .Surg Radiol Anat, 1999, 21(1): 7-15.
Wang Q Liu J Shi Y Short-term effects of a dynamic neutralization system (Dynesys) for multi-segmental lumbar disc herniation Eur Spine J 2016 25 5 1409 1416 10.1007/s00586-015-4307-1 Wang Q, Liu J, Shi Y, et al .Short-term effects of a dynamic neutralization system (Dynesys) for multi-segmental lumbar disc herniation[J ] .Eur Spine J, 2016, 25(5):1409-1416.DOI:10.1007/s00586-015-4307-1.
Ekman P Möller H Shalabi A A prospective randomised study on the long-term effect of lumbar fusion on adjacent disc degeneration Eur Spine J 2009 18 8 1175 1186 10.1007/s00586-009-0947-3 Ekman P, Möller H, Shalabi A, et al .A prospective randomised study on the long-term effect of lumbar fusion on adjacent disc degeneration[J ] .Eur Spine J, 2009, 18(8): 1175-1186.DOI: 10.1007/s00586-009-0947-3.
徐 灿华 吴 增晖 郑 轶 腰椎极外侧入路椎间融合术在腰椎融合术后邻近节段病变中的初步应用 第三军医大学学报 2014 36 17 1837 1841 http://aammt.tmmu.edu.cn/oa/DArticle.aspx?type=view&id=201402044 徐灿华, 吴增晖, 郑轶, 等.腰椎极外侧入路椎间融合术在腰椎融合术后邻近节段病变中的初步应用[J].第三军医大学学报, 2014, 36(17):1837-1841.
Xu C H Wu Z H Zheng Y Extreme lateral intervertebral fusion in treatment of adjacent segment deterioration after lumbar fusion:report of 9 cases J Third Mil Med Univ 2014 36 17 1837 1841 http://aammt.tmmu.edu.cn/oa/DArticle.aspx?type=view&id=201402044 Xu C H, Wu Z H, Zheng Y, et al .Extreme lateral intervertebral fusion in treatment of adjacent segment deterioration after lumbar fusion:report of 9 cases[J ] .J Third Mil Med Univ, 2014, 36(17):1837-1841.
Sears W R Sergides I G Kazemi N Incidence and prevalence of surgery at segments adjacent to a previous posterior lumbar arthrodesis Spine J 2011 11 1 11 20 10.1016/j.spinee.2010.09.026 Sears W R, Sergides I G, Kazemi N, et al .Incidence and prevalence of surgery at segments adjacent to a previous posterior lumbar arthrodesis[J ] .Spine J, 2011, 11(1): 11-20.DOI:10.1016/j.spi nee.2010.09.026.
Liao J C Chen W J Chen L H Surgical outcomes of degenerative spondylolisthesis with L5-S1 disc degeneration: comparison between lumbar floating fusion and lumbosacral fusion at a minimum 5-year follow-up Spine(Phila Pa 1976) 2011 36 19 1600 1607 10.1097/BRS.0b013e3181f99e11 Liao J C, Chen W J, Chen L H, et al .Surgical outcomes of degenerative spondylolisthesis with L5-S1 disc degeneration: comparison between lumbar floating fusion and lumbosacral fusion at a minimum 5-year follow-up[J ] .Spine(Phila Pa 1976), 2011, 36(19):1600-1607.DOI:10.1097/BRS.0b013e3181f99e11.
Park P Garton H J Gala V C Adjacent segment disease after lumbar or lumbosacral fusion: review of the literature Spine(Phila Pa 1976) 2004 29 17 1938 1944 10.1097/01.brs.0000137069.88904.03 Park P, Garton H J, Gala V C, et al .Adjacent segment disease after lumbar or lumbosacral fu sion: review of the literature[J ] .Spine(Phila Pa 1976), 2004, 29(17):1938-1944.
Schmoelz W Huber J F Nydegger T Dynamic stabilization of the lumbar spine and its effects on adjacent segments: an in vitro experiment J Spinal Disord Tech 2003 16 4 418 423 10.1097/00024720-200308000-00015 Schmoelz W, Huber J F, Nydegger T, et al .Dynamic stabilization of the lumbar spine and its effects on adjacent segments: an in vitro experiment[J ] .J Spinal Disord Tech, 2003, 16(4):418-423.
Gédet P Haschtmann D Thistlethwaite P A Comparative biomechanical investigation of a modular dynamic lumbar stabilization system and the Dynesys system Eur Spine J 2009 18 10 1504 1511 10.1007/s00586-009-1077-7 Gédet P, Haschtmann D, Thistlethwaite P A, et al .Comparative biomechanical investigation of a modular dynamic lumbar stabilization system and the Dynesys system[J ] .Eur Spine J, 2009, 18(10):1504-1511.DOI:10.1007/s00586-009-1077-7.
Lee C H Jahng T A Hyun S J Dynamic stabilization using the Dynesys system versus posterior lumbar interbody fusion for the treatment of degenerative lumbar spinal disease: a clinical and radiological outcomes-based meta-analysis Neurosurg Focus 2016 40 1 E7 10.3171/2015.10.FOCUS15426 Lee C H, Jahng T A, Hyun S J, et al .Dynamic stabilization using the Dynesys system versus posterior lumbar interbody fusion for the treatment of degenerative lumbar spinal disease: a clinical and radiological outcomes-based meta-analysis[J ] .Neurosurg Focus, 2016, 40(1):E7.DOI: 10.3171/2015.10.FOCUS15426.
Lee S E Jahng T A Kim H J Clinical Experiences of Non-fusion Dynamic Stabilization Surgery for Adjacent Segmental Pathology after Lumbar Fusion Int J Spine Surg 2016 10 8 10.14444/3008 Lee S E, Jahng T A, Kim H J, et al .Clinical Exper iences of Non-fusion Dynamic Stabilization Surgery for Adjacent Segmental Pathology after Lumbar Fusion[J ] .Int J Spine Surg, 2016, 10: 8.DOI: 10.14444/3008.
Payer M Smoll N R Oezkan N Dynamic transpedicular stabilisation and decompression in single-level degenerative anterolisthesis and stenosis Acta Neurochir (Wien) 2014 156 2 221 227 10.1007/s00701-013-1956-x Payer M, Smoll N R, Oezkan N, et al .Dynamic transpedicular stabilisation and decompression in single-level degenerative anterolisthesis and stenosis[J ] .Acta Neurochir (Wien), 2014, 156(2):221-227.DOI: 10.1007/s00701-013-1956-x.
Vaga S Brayda-Bruno M Perona F Molecular MR imaging for the evaluation of the effect of dynamic stabilization on lumbar intervertebral discs Eur Spine J 2009 18 Suppl 1 40 48 10.1007/s00586-009-0996-7 Vaga S, Brayda-Bruno M, Perona F, et al .Molecular MR imaging for the evalua tion of the effect of dynamic stabilization on lumbar intervertebral discs[J ] .Eur Spine J, 2009, 18(Suppl 1):40-48.DOI:10.1007/s00586-009-0996-7.
Kumar A Beastall J Hughes J Disc changes in the bridged and adjacent segments after Dynesys dynamic stabilization system after two years Spine (Phila Pa 1976) 2008 33 26 2909 2914 10.1097/BRS.0b013e31818bdca7 Kumar A, Beastall J, Hughes J, et al .Disc changes in the bridged and adjacent segments after Dynesys dynamic stabilization system after two years[J ] .Spine (Phila Pa 1976), 2008, 33(26): 2909-2914.DOI: 10.1097/BRS.0b013e31818bdca7.
Kaito T Hosono N Mukai Y Induction of early degeneration of the adjacent segment after posterior lumbar interbody fusion by excessive distraction of lumbar disc space J Neurosurg Spine 2010 12 6 671 679 10.3171/2009.12.SPINE08823 Kaito T, Hosono N, Mukai Y, et al .Induction of early degeneration of the adjacent segment after posterior lumbar interbody fusion by excessive distraction of lumbar disc space[J ] .J Neurosurg Spine, 2010, 12(6): 671-679.DOI: 10.3171/2009.12.SPINE08823.
Tang S Rebholz B J Does lumbar microdiscectomy affect adjacent segmental disc degeneration? A finite element study J Surg Res 2013 182 1 62 67 10.1016/j.jss.2012.09.012 Tang S, Rebholz B J.Does lumbar microdiscectomy affect adjacent segmental disc degeneration? A finite element study[J].J Surg Res, 2013, 182(1): 62-67.DOI: 10.1016/j.jss.2012.09.012.
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