Index-level Fusion and Adjacent Segment Disease Following Dynamic Stabilization for Lumbar Degenerative Disc Disease: Illustrative Case

Overview

Journal J Neurosurg Case Lessons

Specialty Neurology

Date 2024 Jul 15

PMID 39008913

Authors

Kathleen R Ran

Tej D Azad

Bhavya Pahwa

Lydia J Bernhardt

Ali Bydon

Affiliations

Soon will be listed here.

Abstract

Background: Dynesys dynamic stabilization (DDS) is an alternative to surgical fusion for the operative management of degenerative lumbar spondylosis. Compared to rigid instrumentation and fusion, DDS is purported to preserve a higher degree of spinal range of motion and reduce the risk of developing adjacent segment disease (ASD).

Observations: A 60-year-old female presented with severe back pain and bilateral leg pain, which had progressed over the prior 4 years. Nine years earlier, she had undergone DDS system implantation at L5-S1 for lumbar stenosis and spondylosis. Repeat imaging revealed an unintended fusion at the index level (L5-S1) and ASD causing severe lateral recess stenosis at L4-5. She underwent DDS system removal, decompression at L4-5, and extension of the fusion to L4.

Lessons: Although DDS has been marketed as a motion-preserving system that avoids fusion and reduces the risk of ASD, unintended index-level fusion and ASD can still occur after DDS system surgery. These potential complications should be assessed when determining the optimal primary surgical treatment for patients with lumbar degenerative disc disease. https://thejns.org/doi/10.3171/CASE24179.

References

St-Pierre G, Jack A, Siddiqui M, Henderson R, Nataraj A . Nonfusion Does Not Prevent Adjacent Segment Disease: Dynesys Long-term Outcomes With Minimum Five-year Follow-up. Spine (Phila Pa 1976). 2015; 41(3):265-73. DOI: 10.1097/BRS.0000000000001158. View

Evaniew N, Swamy G, Jacobs W, Bouchard J, Cho R, Manson N . Lumbar Fusion Surgery for Patients With Back Pain and Degenerative Disc Disease: An Observational Study From the Canadian Spine Outcomes and Research Network. Global Spine J. 2021; 12(8):1676-1686. PMC: 9609527. DOI: 10.1177/2192568220985470. View

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

Pham M, Mehta V, Patel N, Jakoi A, Hsieh P, Liu J . Complications associated with the Dynesys dynamic stabilization system: a comprehensive review of the literature. Neurosurg Focus. 2016; 40(1):E2. DOI: 10.3171/2015.10.FOCUS15432. View

Akyoldas G, Cevik O, Suzer T, Sasani M, Oktenoglu T, Ozer A . Dynamic Stabilization of the Lumbar Spine using the Dynesys® System. Turk Neurosurg. 2019; 30(2):190-193. DOI: 10.5137/1019-5149.JTN.26475-19.2. View

Hu A, Sun C, Liang Y, Wang H, Li X, Dong J . Multi-segmental lumbar spinal stenosis treated with Dynesys stabilization versus lumbar fusion in elderly patients: a retrospective study with a minimum of 5 years' follow-up. Arch Orthop Trauma Surg. 2019; 139(10):1361-1368. DOI: 10.1007/s00402-019-03234-3. View

Wu H, Pang Q, Jiang G . Medium-term effects of Dynesys dynamic stabilization versus posterior lumbar interbody fusion for treatment of multisegmental lumbar degenerative disease. J Int Med Res. 2017; 45(5):1562-1573. PMC: 5718723. DOI: 10.1177/0300060517708104. View

Fritzell P, Hagg O, Wessberg P, Nordwall A . 2001 Volvo Award Winner in Clinical Studies: Lumbar fusion versus nonsurgical treatment for chronic low back pain: a multicenter randomized controlled trial from the Swedish Lumbar Spine Study Group. Spine (Phila Pa 1976). 2001; 26(23):2521-32; discussion 2532-4. DOI: 10.1097/00007632-200112010-00002. View

Fay L, Huang W, Chang C, Chang H, Tsai T, Tu T . Unintended facet fusions after Dynesys dynamic stabilization in patients with spondylolisthesis. J Neurosurg Spine. 2018; 30(3):353-361. DOI: 10.3171/2018.8.SPINE171328. View

10.

Zhang Y, Zhang Z, Li F, Sun T, Shan J, Guan K . Long-Term Outcome of Dynesys Dynamic Stabilization for Lumbar Spinal Stenosis. Chin Med J (Engl). 2018; 131(21):2537-2543. PMC: 6213831. DOI: 10.4103/0366-6999.244107. View

11.

Bydon M, Macki M, de la Garza-Ramos R, McGovern K, Sciubba D, Wolinsky J . Incidence of Adjacent Segment Disease Requiring Reoperation After Lumbar Laminectomy Without Fusion: A Study of 398 Patients. Neurosurgery. 2015; 78(2):192-9. DOI: 10.1227/NEU.0000000000001007. View

12.

Aiki H, Ohwada O, Kobayashi H, Hayakawa M, Kawaguchi S, Takebayashi T . Adjacent segment stenosis after lumbar fusion requiring second operation. J Orthop Sci. 2005; 10(5):490-5. DOI: 10.1007/s00776-005-0919-3. View

13.

Zhang C, Wang L, Hou T, Luo L, Zhao C, Gan Y . The influence of L4-S1 Dynesys® dynamic stabilization versus fusion on lumbar motion and its relationship with lumbar degeneration: a retrospective study. J Orthop Surg Res. 2017; 12(1):99. PMC: 5485709. DOI: 10.1186/s13018-017-0597-9. View

14.

Park P, Garton H, Gala V, Hoff J, McGillicuddy J . Adjacent segment disease after lumbar or lumbosacral fusion: review of the literature. Spine (Phila Pa 1976). 2004; 29(17):1938-44. DOI: 10.1097/01.brs.0000137069.88904.03. View

15.

Lee C, Hwang C, Lee S, Ahn Y, Kim Y, Lee D . Risk factors for adjacent segment disease after lumbar fusion. Eur Spine J. 2009; 18(11):1637-43. PMC: 2899393. DOI: 10.1007/s00586-009-1060-3. View

16.

Song K, Choi B, Jeon T, Lee K, Chang H . Adjacent segment degenerative disease: is it due to disease progression or a fusion-associated phenomenon? Comparison between segments adjacent to the fused and non-fused segments. Eur Spine J. 2011; 20(11):1940-5. PMC: 3207329. DOI: 10.1007/s00586-011-1864-9. View

17.

Zhang Y, Shan J, Liu X, Li F, Guan K, Sun T . Comparison of the Dynesys Dynamic Stabilization System and Posterior Lumbar Interbody Fusion for Lumbar Degenerative Disease. PLoS One. 2016; 11(1):e0148071. PMC: 4732666. DOI: 10.1371/journal.pone.0148071. View

18.

Grob D, Benini A, Junge A, Mannion A . Clinical experience with the Dynesys semirigid fixation system for the lumbar spine: surgical and patient-oriented outcome in 50 cases after an average of 2 years. Spine (Phila Pa 1976). 2005; 30(3):324-31. DOI: 10.1097/01.brs.0000152584.46266.25. View

19.

Ghogawala Z, Resnick D, Glassman S, Dziura J, Shaffrey C, Mummaneni P . Randomized controlled trials for degenerative lumbar spondylolisthesis: which patients benefit from lumbar fusion?. J Neurosurg Spine. 2016; 26(2):260-266. DOI: 10.3171/2016.8.SPINE16716. View

20.

Ghiselli G, Wang J, Bhatia N, Hsu W, Dawson E . Adjacent segment degeneration in the lumbar spine. J Bone Joint Surg Am. 2004; 86(7):1497-503. DOI: 10.2106/00004623-200407000-00020. View