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Abstract
This study evaluated differences in outcome variables between dynamic stabilization adjacent to fusion (DATF) and posterior lumbar interbody fusion (PLIF) for the treatment of lumbar degenerative disease. A systematic review of PubMed, EMBASE, and Cochrane was performed. The variables of interest included clinical adjacent segment pathologies (CASPs), radiological adjacent segment pathologies (RASPs), lumbar lordosis (LL), visual analogue scale (VAS) of back (VAS-B) and leg (VAS-L), Oswestry disability index (ODI), Japanese Orthopaedic Association (JOA) score, duration of surgery (DS), estimated blood loss (EBL), complications, and reoperation rate. Nine articles identified as meeting all of the inclusion criteria. DATF was better than PLIF in proximal RASP, CASP, and ODI during 3 months follow-up, VAS-L. However, no significant difference between DATF and PLIF was found in distal RASP, LL, JOA score, VAS-B, ODI after 3 months follow-up, complication rates, and reoperation rate. These further confirmed that DATF could decrease the proximal ASP both symptomatically and radiographically as compared to fusion group; however, the influence of DATF on functional outcome was similar with PLIF. The differences between hybrid surgery and topping-off technique were located in DS and EBL in comparison with PLIF. Our study confirmed that DATF could decrease the proximal ASP both symptomatically and radiographically as compared to the fusion group; however, the influence of DATF on functional outcome was similar with PLIF. The difference between hybrid surgery and topping-off technique was not significant in treatment outcomes.
Highlights
Low back pain (LBP) is one of the most important reasons for seeking medical treatment with a prevalence ranging from 59% to 84% [1]
Considering our study showed that no significant between-group difference was found in lumbar lordosis (LL), the preservation of radiological adjacent segment pathologies (RASPs) might not result from the realignment effect of dynamic stabilization adjacent to fusion (DATF)
Our study showed that there was no significant difference between DATF and posterior lumbar interbody fusion (PLIF) in postoperative Japanese Orthopaedic Association (JOA) and visual analogue scale (VAS)-B; the Oswestry disability index (ODI) in DATF was significantly lower than PLIF during 3 months follow-up and a rebound occurred
Summary
Low back pain (LBP) is one of the most important reasons for seeking medical treatment with a prevalence ranging from 59% to 84% [1]. Lumbar degenerative diseases, such as lumbar spinal stenosis, lumbar disc herniation, and lumbar degenerative instability, are common etiologies of LBP and can have a significant influence on the quality of life [2]. Dynamic interspinous spacer devices can reduce the stiffness of the instrumentation to preserve more physiological load transmission, which shows a better restoration of the physiological mechanics of the spinal segments [4]. Khoueir et al [5] defined three types of posterior dynamic stabilization systems: hybrid stabilization device with pedicle screw or rod construct (HSD) such
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