Abstract
Medium- to long-term retrospective evaluation of clinical and radiographic outcome in the treatment of degenerative lumbar diseases with hybrid posterior fixation. Thirty patients were included with the mean age of 47.8 years (range 35 to 60 years). All patients underwent posterior lumbar instrumentation using hybrid fixation for lumbar stenosis with instability (13 cases), degenerative spondylolisthesis Meyerding grade I (6 cases), degenerative disc disease of one or more adjacent levels in six cases and mild lumbar degenerative scoliosis in five patients. Clinical outcomes were evaluated using Oswestry disability index (ODI), Roland and Morris disability questionnaire (RMDQ), and the visual analog scale (VAS) pain scores. All patients were assessed by preoperative, postoperative and follow-up standing plain radiographs and lateral X-rays with flexion and extension. Adjacent disc degeneration was also evaluated by magnetic resonance imaging (MRI) at follow-up. At a mean follow-up of 6.1 years, we observed on X-rays and/or MRI 3 cases of adjacent segment disease (10.0 %): two of them (6.6 %) presented symptoms and recurred a new surgery. The last patient (3.3 %) developed asymptomatic retrolisthesis of L3 not requiring revision surgery. The mean preoperative ODI score was 67.6, RMDQ score was 15.1, VAS back pain score was 9.5, and VAS leg pain score was 8.6. Postoperatively, these values improved to 28.1, 5.4, 3.1, and 2.9, respectively, and remained substantially unchanged at the final follow-up: (27.7, 5.2, 2.9, and 2.7, respectively). After 5-year follow-up, hybrid posterior lumbar fixation presented satisfying clinical outcomes in the treatment of degenerative disease.
Highlights
Over the past decades, spinal fusion with instrumentation has become a common technique in the surgical treatment of symptomatic degenerative diseases of the lumbar spine
At a mean follow-up of 6.1 years, we observed on X-rays and/or magnetic resonance imaging (MRI) 3 cases of adjacent segment disease (10.0 %): two of them (6.6 %) presented symptoms and recurred a new surgery
The mean leg pain visual analog scale (VAS) decreased from a preoperative score of 8.6 of 10 to a mean postoperative score of 2.9 and 2.7 at the last follow-up (p \ 0.05), with a mean final improvement of 59.6 % (p \ 0.05)
Summary
Spinal fusion with instrumentation has become a common technique in the surgical treatment of symptomatic degenerative diseases of the lumbar spine. The primary junctional complications can be facet degeneration, ligament hypertrophy, disc degeneration, and spinal stenosis [5, 8] This adjacent level degeneration is typically seen rostral to a fused segment, but may occur caudal to a fusion, especially when it is performed at the L4–L5 level. The phenomenon is thought to be due to the altered biomechanics of the fused spine, wherein abnormal forces acting upon the intervertebral discs and facet joints adjacent to the fused segment precipitate the accelerated failure of these stabilizing elements [9]. From this evidence for adjacent segment degeneration emerged the concept of ‘‘dynamic’’ or ‘‘non fusion’’ stabilization of the lumbar spine
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