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

Abstract

Introduction: The development of adjacent-segment disease is a recognized consequence of lumbar fusion surgery. Posterior dynamic stabilization, or motion preservation, techniques have been developed which theoretically decrease stress on adjacent segments following fusion. This study presents the experience of using a hybrid dynamic stabilization and fusion construct for degenerative lumbar spine pathology in place of rigid arthrodesis.Methods: A clinical cohort investigation was conducted of 66 consecutive patients (31 female, 35 male; mean age: 53 years, range: 25 – 76 years) who underwent posterior lumbar instrumentation with the Dynesys Transition Optima (DTO) implant (Zimmer-Biomet Spine, Warsaw, IN) hybrid dynamic stabilization and fusion system over a 10-year period. The median length of follow-up was five years. DTO consists of pedicle screw fixation coupled to a rigid rod as well as a flexible longitudinal connecting system. All patients had symptoms of back pain and neurogenic claudication refractory to non-surgical treatment. Patients underwent lumbar arthrodesis surgery in which the hybrid system was used for stabilization instead of arthrodesis of the stenotic adjacent level.Results: Indications for DTO instrumentation were primary degenerative disc disease (n = 52) and failed back surgery syndrome (n = 14). The most common dynamically stabilized and fused segments were L3-L4 (n = 37) and L5-S1 (n = 33), respectively. Thirty-eight patients (56%) underwent decompression at the dynamically stabilized level, and 57 patients (86%) had an interbody device placed at the level of arthrodesis. Complications during the follow-up period included a single case of screw breakage and a single case of pseudoarthrosis. Ten patients (15%) subsequently underwent conversion of the dynamic stabilization portion of their DTO instrumentation to rigid spinal arthrodesis.Conclusion: The DTO system represents a novel hybrid dynamic stabilization and fusion construct. This 10-year experience found the device to be highly effective as well as safe. The technique may serve as an alternative to multilevel arthrodesis. Implantation of a motion-preserving dynamic stabilization device immediately adjacent to a fused level instead of extending a rigid construct may reduce the subsequent development of adjacent-segment disease in this patient population.

Topping-Off Technology versus Posterior Lumbar Interbody Fusion in the Treatment of Lumbar Disc Herniation: A Meta-Analysis

“…e scores of JOA, ODI, and VAS are important indexes to judge the recovery of lumbar functions and the curative effects after operation. It has been reported that topping-off surgery can achieve a good clinical improvement even in the long-term follow-up [2,8,44]. In this analysis, VAS-B and VAS-L in the topping-off group were significantly less than those in the PLIF group; in addition, postoperative ODI in the topping-off group was significantly higher than that in the PLIF group after 3 years; however, postoperative ODI within 3 years and JOA score were similar in both groups.…”

A Hybrid Dynamic Stabilization and Fusion System in Multilevel Lumbar Spondylosis

“…In 2016, Kashkoush et al [ 21 ] conducted a study of 66 patients with 2-level lumbar spondylosis who underwent DTO surgery. For 52 of them (78.8%) it was the first time to receive surgery, and 14 (21.2%) were from failed back syndrome.…”

The use of the DTO™ hybrid dynamic device: a clinical outcome- and radiological-based prospective clinical trial

“…While revision rates of the well-known Dynesys device have been reported up to 34%, to date, there is minimal research regarding the DTO™ [ 25 , 26 ]. Maserati et al reported a non-implant dependant complication rate of 24% but they found no screw breakage or signs for implant loosening [ 18 ].…”