Abstract
BackgroundThe aim of this study is to evaluate the efficacy of Dynesys® posterior dynamic stabilization (PDS) in the treatment of L4–S1 degenerative diseases and to assess the influence of postoperative motion on lumbar degeneration.MethodsIncluded in this retrospective study were patients with L4–S1 degenerative disease who underwent fusion or PDS from September 2010 to September 2014. Clinical outcomes were assessed by preoperative and postoperative visual analog scale (VAS) and Oswestry Disability Index (ODI). Preoperative and postoperative X-rays assessed range of motion (ROM) of the non-surgical and surgical levels and whole lumbar. MRI assessed degeneration of non-surgical levels.ResultsA total of 56 consecutive patients were divided into two groups: group A, PDS, and group B, fusion. Patient demographics and baseline characteristics were similar in the two groups. In both groups, there was a significant difference between preoperative and postoperative VAS and ODI scores (P < 0.05). However, there was a significant difference in a 6-month follow-up ODI between the two groups (P < 0.05). X-rays showed PDS patients partially maintained surgical level ROM and non-surgical level ROM increased less than in the fusion group. MRI showed adjacent segment degeneration (ASD) in both groups, and patients whose preoperative L3–4 Pfirrmann classification was higher than grade 2 had more ASD than lower than grade 2.ConclusionPDS can maintain surgical level ROM and had less influence on whole and non-surgical level ROM. Following PDS, patients recovered faster and had a better lumbar function. It may be a better choice for multi-level lumbar degenerative diseases.
Highlights
The aim of this study is to evaluate the efficacy of Dynesys® posterior dynamic stabilization (PDS) in the treatment of L4–S1 degenerative diseases and to assess the influence of postoperative motion on lumbar degeneration
Recent biomechanical and clinical data show that range of motion (ROM) decreases at the fusion level, leading to ROM at the non-surgical level increase to compensate for the lost ROM, resulting in aggravation at the non-surgical level [2,3,4,5,6,7]
We evaluated the change in ROM before and after L4–S1 PDS (Fig. 1)
Summary
The aim of this study is to evaluate the efficacy of Dynesys® posterior dynamic stabilization (PDS) in the treatment of L4–S1 degenerative diseases and to assess the influence of postoperative motion on lumbar degeneration. Recent biomechanical and clinical data show that range of motion (ROM) decreases at the fusion level, leading to ROM at the non-surgical level increase to compensate for the lost ROM, resulting in aggravation at the non-surgical level [2,3,4,5,6,7]. These conditions, in turn, can accelerate the Because of improved understanding of lumbar motion, surgeons consider how to treat lumbar degenerative disease while maintaining ROM. A systematic review comparing fusion with artificial disc replacement showed the lumbar artificial disc, which maintained ROM at the surgical level, had less effect on the adjacent level than
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