Abstract
Arthrodesis has always been considered the main treatment of degenerative lumbar disease. Adjacent segment degeneration is one of the major topics related to fusion surgery. Non-fusion surgery may prevent this because of the protective effect of persisting segmental motion. The aims of the study were (1) to describe the radiological outcomes in the adjacent vertebral segment after lumbar stabilization with DSS-HPS® system and (2) to verify the hypothesis that this system prevents the degeneration of the adjacent segment. This is a retrospective monocentric analysis of twenty-seven patients affected by degenerative lumbar disease underwent spinal hybrid stabilization with the DSS-HPS® system between January 2016 and January 2019. All patients completed 1-year radiological follow-up. Preoperative X-rays and magnetic resonance images, as well as postoperative radiographs at 1, 6 and 12 months, were evaluated by one single observer. Pre- and post-operative anterior and posterior disc height at the dynamic (DL) and adjacent level (AL) were measured; segmental angle (SA) of the dynamized level were measured. There was a statistically significant decrease of both anterior (p = 0.0003 for the DL, p = 0.036 for the AL) and posterior disc height (p = 0.00000 for the DL, p = 0.00032 for the AL); there were a statistically significant variations of the segmental angle (p = 0.00000). Eleven cases (40.7%) of radiological progression of disc degeneration were found. The DSS-HPS® system does not seem to reduce progression of lumbar disc degeneration in a radiologic evaluation, both in the dynamized and adjacent level.
Highlights
Spinal arthrodesis is considered the gold standard technique in the surgical treatment of symptomatic degenerative spine disease
While modern technologies can result in increased fusion rates near 100%, there is a large evidence that fusion may have undesirable long-term effects on the non-fused spine, on the adjacent segments [1,2,3]
A distinction must be given between adjacent segment degeneration (ASDeg) and adjacent segment disease (ASDis): ASDeg is an asymptomatic radiological degeneration, while ASDis is associated to clinical manifestations [10]
Summary
Spinal arthrodesis is considered the gold standard technique in the surgical treatment of symptomatic degenerative spine disease. Biomechanical changes in the transition zone from a rigid to a mobile system are assumed to lead to a hypermobility of the adjacent non-fused levels, increased intradiscal pressure and increased facets load [5,6,7]. Another theory links it with patients’ propensity to develop degenerative spine disease [8]. The incidence of clinical ASD is reported to range from 5.2% to 18.5% at 5 years and 10.6% to 36.1% at 10 years [7,9,11,12,13,14,15]
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