Dynamic stabilization for L4–5 spondylolisthesis: comparison with minimally invasive transforaminal lumbar interbody fusion with more than 2 years of follow-up

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>In the past decade, dynamic stabilization has been an emerging option of surgical treatment for lumbar spondylosis. However, the application of this dynamic construct for mild spondylolisthesis and its clinical outcomes remain uncertain. This study aimed to compare the outcomes of Dynesys dynamic stabilization (DDS) with minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) for the management of single-level spondylolisthesis at L4–5.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>This study retrospectively reviewed 91 consecutive patients with Meyerding Grade I spondylolisthesis at L4–5 who were managed with surgery. Patients were divided into 2 groups: DDS and MI-TLIF. The DDS group was composed of patients who underwent standard laminectomy and the DDS system. The MI-TLIF group was composed of patients who underwent MI-TLIF. Clinical outcomes were evaluated by visual analog scale for back and leg pain, Oswestry Disability Index, and Japanese Orthopaedic Association scores at each time point of evaluation. Evaluations included radiographs and CT scans for every patient for 2 years after surgery.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>A total of 86 patients with L4–5 spondylolisthesis completed the follow-up of more than 2 years and were included in the analysis (follow-up rate of 94.5%). There were 64 patients in the DDS group and 22 patients in the MI-TLIF group, and the overall mean follow-up was 32.7 months. Between the 2 groups, there were no differences in demographic data (e.g., age, sex, and body mass index) or preoperative clinical evaluations (e.g., visual analog scale back and leg pain, Oswestry Disability Index, and Japanese Orthopaedic Association scores). The mean estimated blood loss of the MI-TLIF group was lower, whereas the operation time was longer compared with the DDS group (both p &lt; 0.001). For both groups, clinical outcomes were significantly improved at 6, 12, 18, and 24 months after surgery compared with preoperative clinical status. Moreover, there were no differences between the 2 groups in clinical outcomes at each evaluation time point. Radiological evaluations were also similar and the complication rates were equally low in both groups.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>At 32.7 months postoperation, the clinical and radiological outcomes of DDS were similar to those of MI-TLIF for Grade I degenerative spondylolisthesis at L4–5. DDS might be an alternative to standard arthrodesis in mild lumbar spondylolisthesis. However, unlike fusion, dynamic implants have issues of wearing and loosening in the long term. Thus, the comparable results between the 2 groups in this study require longer follow-up to corroborate.</jats:p></jats:sec>

Evaluation of a Hybrid Dynamic Stabilization and Fusion System in the Lumbar Spine: A 10 Year Experience

“…There is an abundance of literature regarding traditional, non-hybrid Dynesys instrumentation and its associated complications [ 26 - 27 ]. Infection rates have been generally well controlled during these procedures [ 12 , 27 ].…”

Medium-term effects of Dynesys dynamic stabilization versus posterior lumbar interbody fusion for treatment of multisegmental lumbar degenerative disease

“…The inclusion criteria were involvement of two or more lumbar segments, neurogenic claudication caused by lumbar spinal stenosis, or low back or leg pain caused by degenerative intervertebral disc disease. 4 – 6 The exclusion criteria were severe osteoporosis; severe spinal deformity; grade ≥2 lumbar degenerative spondylolisthesis; progressive intervertebral disc degeneration; serious instability associated with lumbar spine disease; obesity (body mass index of ≥30 kg/m 2 ); serious heart, brain, or lung disease; trauma; infection; malignant tumors; history of lumbar spine surgery; and pelvic-related disease.…”

Unintended facet fusions after Dynesys dynamic stabilization in patients with spondylolisthesis

“…Furthermore, patients with immobile segmental motion (< 3°) on lateral dynamic radiographs would have been recommended for fusion procedures rather than DDS. Surprisingly, in our series of DDS, 4,6,[12][13][14]28,29 a substantial portion of the patients who underwent dynamic stabilization ended up with little segmental mobility and were found to have the facets fused. Therefore, the present study was designed to demonstrate that spondylolisthesis could be a risk factor of the limited segmental mobility found after DDS, although DDS was originally designed for preservation of motion and avoidance of fusion.…”

“…We conducted studies to compare lumbar fusion with dynamic stabilization with an average follow-up of more than 2 years. 14,15 Kuo et al first examined 86 patients with L4-5 spondylolisthesis and demonstrated that the clinical and radiological outcomes of DDS were similar to those of minimally invasive transforaminal lumbar interbody fusion (mi-TLIF) for grade I spondylolisthesis after approximately 2.5 years postoperatively. Although DDS might be an alternative to standard arthrodesis in mild lumbar spondylolisthesis, the dynamic pedicle screws could have other issues like wearing and loosening in long-term follow-up.…”