Surgical Treatment of Lumbar Degenerative Problems with CD HORIZON BalanC Spinal System

Abstract

Introduction Adjacent segment degeneration (ASD) is a common (34%) problem following posterior spinal fusions which may deteriorate functional outcomes in long-term follow-up. CD HORIZON BalanC rod has a dynamic portion made of silicone and polyetheretherketone (PEEK) aiming motion preservation, and fusion portion is entirely made of PEEK. The aim of this study is to evaluate the efficacy of CD HORIZON BalanC Spinal System in the treatment of multilevel lumbar degenerative disease and to identify fusion and ASD rates with MRI and 3D CT scan for both adjacent (AL) and dynamic (DL) levels with clinical outcomes. Patients and Methods A total of 30 patients (18 F and 12 M) mean age 47.3 years (range, 26–65 years) with 50 levels of TLIF with more than 2-year follow-up were reviewed. TLIF were single level in 12 patients, 2 levels in 16 patients and 3 levels in 2 patients. Pre-op, post-op AP/L X-rays were measured for pelvic and sagittal parameters. Disc angles, ROM, anterior disc height (ADH), and posterior disc height (PDH) were measured for AL and DL. Disc and facet degenerations for AL and DL were evaluated with MRI and 3D CT scan at the end of 2-year follow-up. Clinical evaluation was done with ODI and VAS. Results Mean follow-up was 26.3 months (range, 24–38 months). Av instrumented levels was 3.33 (range, 2–5) and av. fused levels was 1.66 (range, 1–3). TLIF were at L5–S1 in 23 patients, L4–L5 in 20 patients, L3–L4 in 6 patients, and L2–L3 in 1 patient. Pre-op LL was restored to 42.7 and 49.3 degrees. There were no significant differences in ADH, PDH, and disc angles between pre-op and follow-up for AL and DL ( p > 0.05). Pre-op AL av. ROM of 5.85 degrees changed to 6.57 degrees. Pre-op DL av. ROM of 6.72 degrees was decreased to 5.07 degrees with a limitation of 24.6% post-op. There were no significant changes in terms of disc and facet degeneration grades for both AL and DL at final follow-up ( p > 0.05). 3D CT evaluation revealed solid fusions for all TLIF levels. Mean of 43.51% ODI was improved to 18.93 and pre-op VAS score 7.2 was improved to 2.2. Conclusion In lumbar spinal fusion surgeries performed with CD HORIZON BalanC Spinal system, MRI and 3D CT scan studies at the end of 2-year follow-up did not show any significant deterioration in terms of disc and facet degeneration for AL and DL. Dynamic portion of the rod limits ROM by 24.6% at dynamic level. Dynamic portion seems to be effective in preventing ASD at the end of 2-year follow-up.