Clinical efficacy and radiographic K-rod stabilization for the treatment of multilevel degenerative lumbar spinal stenosis

Abstract

Background This study compares the use of radiographic K-Rod dynamic stabilization to the rigid system for the treatment of multisegmental degenerative lumbar spinal stenosis (MDLSS). Methods A total of 40 patients with MDLSS who underwent surgical treatment using the K-Rod (n = 25) and rigid systems (n = 15) from March 2013 to March 2017 were assessed. The mean follow-up period was 29.1 months. JOA, ODI, VAS and modified Macnab were assessed. Radiographic evaluations included lumbar lordosis angle, ISR value, operative and proximal adjacent ROM. Changes in intervertebral disc signal were classified according to Pfirrmann grade and UCLA system. Results JOA, ODI and VAS changed significantly after the operation to comparable levels between the groups. However, the lumbar lordosis significantly decreased at final follow-up between both groups. The ROM of the proximal adjacent segment increased at final follow-up, but the number of fixed segment ROMs in the K-Rod group were significantly lower at the final follow-up than observed prior to the operation. In both groups, the ISR of the proximal adjacent segment decreased, most notably in the rigid group. The ISR of the non-fusion fixed segments in the K-Rod group increased post-operation and during final follow-up. The levels of adjacent segment degeneration were higher in the rigid group vs. the K-Rod group according to modified Pfirrmann grading and the UCLA system. Conclusions Compared with the rigid system for treatment of MDLSS, dynamic K-Rod stabilization achieves improved radiographic outcomes and improves the mobility of the stabilized segments, minimizing the influence on the proximal adjacent segment.

The effect of posterior lumbar dynamic fixation and intervertebral fusion on paraspinal muscles

“…On the other hand, the K-rod dynamic internal fixation technique required only a small unilateral dissection, with a small incision. Moreover, the unilateral lamina of a single segment was required to be exposed on opening the lamina to remove the herniated intervertebral disc, which significantly shortened the operation time [ 23 ]. Furthermore, the paravertebral soft tissue and the blood supply were lesser damaged, such that the blood loss was lesser with lesser postoperative drainage.…”

“…Dynamic stabilization system has been found to decrease adjacent segment degeneration, reduce the loading on the intervertebral disc and improve spinal stability [ 21 , 22 ]. The K-rod internal fixation system is a relatively novel, dynamic spine stability device with a positive clinical outcome recorded in both short and medium terms, which was consisted of titanium alloy pedicle screws, polyetheretherketone (PEEK) rod and titanium alloy tubes [ 23 ]. This intervention can effectively reconstruct the stability of the spine and retain the spinal movement function [ 23 , 24 ].…”

“…The K-rod internal fixation system is a relatively novel, dynamic spine stability device with a positive clinical outcome recorded in both short and medium terms, which was consisted of titanium alloy pedicle screws, polyetheretherketone (PEEK) rod and titanium alloy tubes [ 23 ]. This intervention can effectively reconstruct the stability of the spine and retain the spinal movement function [ 23 , 24 ]. In addition, the internal fixation system can provide single-segment or multi-segment non-fusion solutions as well as can be combined with rigid internal fixation to achieve a diversified combination of fusion and non-fusion effects.…”