A Hybrid Dynamic Stabilization and Fusion System in Multilevel Lumbar Spondylosis

Overview

Journal Neurospine

Date 2018 Aug 22

PMID 30126265

Citations 11

Authors

Li-Yu Fay

Chih-Chang Chang

Hsuan-Kan Chang

Tsung-Hsi Tu

Tzu-Yun Tsai

Ching-Lan Wu

Wen-Cheng Huang

Jau-Ching Wu

Henrich Cheng

Affiliations

Soon will be listed here.

Abstract

Objective: The Dynesys-Transition-Optima (DTO) hybrid system was designed to achieve arthrodesis and stabilization in patients with lumbar degeneration. Satisfactory outcomes were demonstrated previously. However, no study has evaluated the effects of using the DTO system in patients with lumbar spondylolisthesis or stenosis.

Methods: This retrospective study included 35 consecutive patients with multilevel lumbar degeneration with or without spondylolisthesis who underwent surgery using the DTO system. Imaging studies included pre- and postoperative radiography, magnetic resonance imaging, and computed tomography. The clinical outcomes were measured by Japanese Orthopedic Association (JOA) scores, Oswestry Disability Index (ODI) scores, and a visual analogue scale (VAS) for back and leg pain.

Results: Thirty patients (85.7%) with a mean age of 61.9 years completed the follow-up, with a mean duration of 35.1 months. There were 21 patients in the spondylolisthesis group and 9 in the stenosis group. The spondylolisthesis group had worse functional scores than the stenosis group preoperatively. After DTO surgery, all patients showed significant improvements in clinical outcomes, including VAS for back and leg pain, ODI, and JOA scores (p < 0.05). There were no significant differences in clinical outcomes between the 2 groups. At a 2-year follow-up, lumbar alignment was well maintained in both groups (p = 0.116). There were no significant differences in lumbar alignment between the 2 groups.

Conclusion: During a follow-up period of over 2 years, both patients with spondylolisthesis and those with stenosis showed improvements and similar disability and pain scores after surgery using the DTO system. Lumbar alignment was also well maintained.

Citing Articles

The Effect of Osteopenia and Osteoporosis on Screw Loosening in MIS-TLIF and Dynamic Stabilization.

Chang H, Chang C, Cheng Y, Wu C, Tu T, Wu J Global Spine J. 2024; :21925682241290747.

PMID: 39352395 PMC: 11559864. DOI: 10.1177/21925682241290747.

A Biomechanical Comparison of 2 Different Topping-off Devices and Their Influence on the Sacroiliac Joint Following Lumbosacral Fusion Surgery.

Fan W, Yang S, Chen J, Guo L, Zhang M Neurospine. 2024; 21(1):244-252.

PMID: 38317555 PMC: 10992661. DOI: 10.14245/ns.2347108.554.

A Retrospective Observational Study to Evaluate Adjacent Segmental Degenerative Change with the Dynesys-Transition-Optima Instrumentation System.

Li C, Chen S, Chen W, Tsou H, Tzeng C, Chen T J Clin Med. 2024; 13(2).

PMID: 38276088 PMC: 10816879. DOI: 10.3390/jcm13020582.

Comparison of Cortical Bone Trajectory to Pedicle-Based Dynamic Stabilization: An Analysis of 291 Patients.

Chang C, Chang H, Ko C, Wu C, Kuo Y, Tu T Neurospine. 2023; 20(1):308-316.

PMID: 37016878 PMC: 10080437. DOI: 10.14245/ns.2244888.444.

Biomechanical Effect of Hybrid Dynamic Stabilization Implant on the Segmental Motion and Intradiscal Pressure in Human Lumbar Spine.

Hsiao C, Tsai Y, Yen C, Li Y, Hsiao H, Tu Y Bioengineering (Basel). 2023; 10(1).

PMID: 36671603 PMC: 9854656. DOI: 10.3390/bioengineering10010031.

References

Lee S, Jahng T, Kim H . Hybrid Surgery Combined with Dynamic Stabilization System and Fusion for the Multilevel Degenerative Disease of the Lumbosacral Spine. Int J Spine Surg. 2015; 9:45. PMC: 4603259. DOI: 10.14444/2045. View

Kuo C, Chang P, Tu T, Fay L, Chang H, Wu J . The Effect of Lumbar Lordosis on Screw Loosening in Dynesys Dynamic Stabilization: Four-Year Follow-Up with Computed Tomography. Biomed Res Int. 2016; 2015:152435. PMC: 4686613. DOI: 10.1155/2015/152435. View

Schaeren S, Broger I, Jeanneret B . Minimum four-year follow-up of spinal stenosis with degenerative spondylolisthesis treated with decompression and dynamic stabilization. Spine (Phila Pa 1976). 2008; 33(18):E636-42. DOI: 10.1097/BRS.0b013e31817d2435. View

Bridwell K, Sedgewick T, OBrien M, Lenke L, Baldus C . The role of fusion and instrumentation in the treatment of degenerative spondylolisthesis with spinal stenosis. J Spinal Disord. 1993; 6(6):461-72. DOI: 10.1097/00002517-199306060-00001. View

Bassewitz H, Herkowitz H . Lumbar stenosis with spondylolisthesis: current concepts of surgical treatment. Clin Orthop Relat Res. 2001; (384):54-60. View

Cheng Y, Chang P, Wu J, Chang C, Fay L, Tu T . Letter to the Editor: Pedicle screw-based dynamic stabilization and adjacent-segment disease. J Neurosurg Spine. 2016; 26(3):405-406. DOI: 10.3171/2016.7.SPINE16816. View

Vaccaro A, Garfin S . Internal fixation (pedicle screw fixation) for fusions of the lumbar spine. Spine (Phila Pa 1976). 1995; 20(24 Suppl):157S-165S. View

Yeh M, Kuo C, Wu J, Huang W, Tu T, Fay L . Changes of Facet Joints After Dynamic Stabilization: Continuous Degeneration or Slow Fusion?. World Neurosurg. 2018; 113:e45-e50. DOI: 10.1016/j.wneu.2018.01.148. View

Glassman S, Carreon L, Djurasovic M, Dimar J, Johnson J, Puno R . Lumbar fusion outcomes stratified by specific diagnostic indication. Spine J. 2008; 9(1):13-21. DOI: 10.1016/j.spinee.2008.08.011. View

10.

Schnake K, Schaeren S, Jeanneret B . Dynamic stabilization in addition to decompression for lumbar spinal stenosis with degenerative spondylolisthesis. Spine (Phila Pa 1976). 2006; 31(4):442-9. DOI: 10.1097/01.brs.0000200092.49001.6e. View

11.

Fay L, Wu J, Tsai T, Tu T, Wu C, Huang W . Intervertebral disc rehydration after lumbar dynamic stabilization: magnetic resonance image evaluation with a mean followup of four years. Adv Orthop. 2013; 2013:437570. PMC: 3657439. DOI: 10.1155/2013/437570. View

12.

Fischgrund J . The argument for instrumented decompressive posterolateral fusion for patients with degenerative spondylolisthesis and spinal stenosis. Spine (Phila Pa 1976). 2004; 29(2):173-4. DOI: 10.1097/01.BRS.0000111142.76601.1A. View

13.

Fritzell P, Hagg O, Nordwall A . Complications in lumbar fusion surgery for chronic low back pain: comparison of three surgical techniques used in a prospective randomized study. A report from the Swedish Lumbar Spine Study Group. Eur Spine J. 2003; 12(2):178-89. PMC: 3784840. DOI: 10.1007/s00586-002-0493-8. View

14.

Kuo C, Chang P, Wu J, Chang H, Fay L, Tu T . Dynamic stabilization for L4-5 spondylolisthesis: comparison with minimally invasive transforaminal lumbar interbody fusion with more than 2 years of follow-up. Neurosurg Focus. 2016; 40(1):E3. DOI: 10.3171/2015.10.FOCUS15441. View

15.

Fay L, Chang P, Wu J, Huang W, Wang C, Tsai T . Dynesys dynamic stabilization-related facet arthrodesis. Neurosurg Focus. 2016; 40(1):E4. DOI: 10.3171/2015.10.FOCUS15404. View

16.

Fay L, Wu J, Tsai T, Wu C, Huang W, Cheng H . Dynamic stabilization for degenerative spondylolisthesis: evaluation of radiographic and clinical outcomes. Clin Neurol Neurosurg. 2012; 115(5):535-41. DOI: 10.1016/j.clineuro.2012.05.036. View

17.

Weinstein J, Lurie J, Tosteson T, Zhao W, Blood E, Tosteson A . Surgical compared with nonoperative treatment for lumbar degenerative spondylolisthesis. four-year results in the Spine Patient Outcomes Research Trial (SPORT) randomized and observational cohorts. J Bone Joint Surg Am. 2009; 91(6):1295-304. PMC: 2686131. DOI: 10.2106/JBJS.H.00913. View

18.

Wu J, Huang W, Tsai H, Ko C, Wu C, Tu T . Pedicle screw loosening in dynamic stabilization: incidence, risk, and outcome in 126 patients. Neurosurg Focus. 2011; 31(4):E9. DOI: 10.3171/2011.7.FOCUS11125. View

19.

Maeda T, Buchowski J, Kim Y, Mishiro T, Bridwell K . Long adult spinal deformity fusion to the sacrum using rhBMP-2 versus autogenous iliac crest bone graft. Spine (Phila Pa 1976). 2009; 34(20):2205-12. DOI: 10.1097/BRS.0b013e3181b0485c. View

20.

Stoll T, Dubois G, Schwarzenbach O . The dynamic neutralization system for the spine: a multi-center study of a novel non-fusion system. Eur Spine J. 2002; 11 Suppl 2:S170-8. PMC: 3611570. DOI: 10.1007/s00586-002-0438-2. View