Disc Changes in the Bridged and Adjacent Segments After Dynesys Dynamic Stabilization System After Two Years

Abstract

Prospective case series. To study the radiologic changes in the intervertebral disc after Dynesys dynamic stabilization. Adjacent segment disc degeneration is one of the potential complications of fusion surgery. It has been proposed that nonfusion motion preservation surgery may prevent accelerated adjacent segment degeneration because of the protective effect of persisting segmental motion. Thirty-two patients who underwent Dynesys procedure between November 2002 and June 2004 and have completed 2-year follow-up MRI scans were included in this study. Preoperative and 2 year postoperative lumbar MRI scans were evaluated by 2 independent observers. T2-weighted mid-sagittal images were used and disc degeneration classified according to the Woodend classification of disc degeneration. Anterior and posterior intervertebral disc heights were also measured. Of the 32 patients, 20 patients underwent Dynesys procedure alone and 12 underwent additional fusion at 1 or more levels. A total of 70 levels were operated on, of which 13 levels were fused.There was a statistically significant increase in the mean Woodend score at the operated levels in the Dynesys alone group, a change from 1.95 before surgery to 2.52 after surgery (P < 0.001). The mean Woodend scores changed from 1.27 preoperative to 1.55 postoperative (P = 0.066) at the proximal adjacent levels, and from 1.37 to 1.62 at the distal levels (P = 0.157). There was good interobserver agreement (weighted kappa score of 0.819). The anterior intervertebral disc height reduced by 2 mm from 9.25 to 7.17 (P < 0.001). The posterior disc height increased by 0.14 mm but this change was not significant. Disc degeneration at the bridged and adjacent segment seems to continue despite Dynesys dynamic stabilization. This continuing degeneration could be due to natural disease progression.