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

Hu, Annan; Sun, Chi; Liang, Yun; Wang, Houlei; Li, Xilei; Dong, Jian

doi:10.1007/s00402-019-03234-3

Cited by 9 publications

(39 citation statements)

References 28 publications

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“…Furthermore, most of the published studies mainly focused on short-term clinical e ciency, whereas reports on medium-and long-term outcomes are rare and have con icting ndings, especially trials involving fusion method as control. 7,16,17,24,29 Hence, we conducted a meta-analysis to compare the radiographic and clinical outcomes between DS and instrumented fusion in patients with or without grade I spondylolisthesis at a minimum follow-up period of 2 years.…”

Section: Discussionmentioning

confidence: 99%

“…After assessing the titles and abstracts, 1531 studies were removed and the remaining 48 articles were downloaded for fulltext veri cation. Finally, one prospective randomized controlled trial 21 , ve prospective clinical studies 3,16,18,19,28 , and eight retrospective studies 4,7,15,17,20,22,24,29 were deemed eligible and included in the meta-analysis. Table 1 summarizes the main characteristics of the included studies.…”

Section: Study Searchmentioning

confidence: 99%

“…Postoperative VAS scores Eleven studies 3, 4, 7, 15-17, 19, 20, 22, 24, 28 provided data on postoperative pain scores (9 studies 3,7,16,17,19,20,22,24,28 were back pain and 9 studies 3,4,7,15,16,19,20,22,28 were leg pain) between Dynesys and fusion groups. The combined results indicated that the postoperative VAS scores for low back pain (MD = -0.23, 95% CI of -0.31 to -0.16, P < 0.01, I 2 = 12%; Figure 3) and leg pain (MD = -0.30, 95% CI of -0.41 to -0.19, P < 0.01, I 2 = 38%; Figure 3) in the DS group were better than those in the fusion group.…”

Section: Clinical Outcomes At Nal Follow-upmentioning

confidence: 99%

“…[3][4][5] Moreover, the preservation of lumbar motion is less considered in fusion instrument, leading to the limited motility of stabilized segments and the increased load on adjacent segments, which may increase the risk of adjacent segment degeneration (ASDeg), adjacent segment disease (ASDis), and severe postoperative functional disabilities. [6][7][8] In recent years, non-fusion systems have been applied clinically to prevent the incidence of adjacent segment pathology (ASP, including ASDeg and ASDis) after lumbar surgeries. 9,10 The Dynesys posterior dynamic stabilization system (Zimmer Inc., Warsaw, IN, USA), which was rst introduced in 1994, is one of the most frequently used dynamic stabilization devices.…”

Section: Introductionmentioning

confidence: 99%

“…In previous works, DS showed no remarkable advantages over fusion method in terms of surgical time, length of hospital stay, intraoperative blood loss, relief in postoperative pain status (VAS scores), and functional status restoration (ODI scores). 3,7,[20][21][22] Meanwhile, DS was reported to be associated with high rates of ASDeg and ASDis. 5,6,23 Although DS is a safe and effective treatment in terms of short-term outcomes, the functional status, preservation of mobility, and prevention of ASP in medium-and long-term periods remain controversial.…”

Section: Introductionmentioning

confidence: 99%

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Radiographic and Clinical Outcomes of Dynesys Dynamic Stabilization Versus Instrumented Fusion for Degenerative Lumbar Spine Diseases With a Minimum Follow-Up Period of 2 Years: A Meta-Analysis

Zhou

Zhang

et al. 2020

Preprint

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ObjectiveDynesys stabilization (DS) is utilized to preserve mobility at the instrumental segments and prevent adjacent segment pathology (ASP) in clinical practice. However, the advantages of DS method remain controversial. This meta-analysis was to compare the radiographic and clinical outcomes between DS and instrumented fusion in patients with or without grade I spondylolisthesis at a minimum follow-up period of 2 years. MethodsWe conducted a comprehensive search of PubMed, EMBASE, Cochrane, and Web of Science databases for potentially eligible articles. Clinical outcomes were assessed in terms of surgical time, intraoperative blood loss, length of hospital stay, in-hospital complications, VAS and ODI scores, screw loosening and breakage, and reoperation. Radiographic outcomes were assessed in terms of postoperative range of movement (ROM) and disc heigh. Moreover, adjacent segment degeneration (ASDeg) and adjacent segment disease (ASDis) were evaluated. Data are expressed as risk ratio or standardized mean difference with the associated 95% confidence intervals. The meta-analysis was performed using RevMan 5.3 and STATA 15.1 software.ResultsFourteen studies with 1078 patients were included in the meta-analysis. The mean durations of follow-up ranged from 26.64 ± 5.16 months to 93.6 ± 16.5 months. The DS group was associated with significantly shorter surgical time, fewer intraoperative blood loss, shorter length of hospital stay, less in-hospital complications, lower postoperative VAS scores for low-back and leg pain than the fusion group (P < 0.05). Moreover, the ROM at the stabilized segments of the fusion group decreased significantly (P < 0.01) and that at the adjacent segments increased significantly compared with those of the Dynesys group (P < 0.01). Additionally, the Dynesys group showed significantly less ASDeg than the fusion group (P < 0.01) but showed no significant advantage over the fusion group in terms of preventing ASDis (P = 0.33). Furthermore, the Dynesys group was insignificantly different from the fusion group in terms of ODI, screw loosening, screw breakage, surgical reoperation, and disc heigh at stabilized and adjacent segments (P > 0.05).ConclusionDynesys stabilization showed satisfactory clinical outcomes and provided additional benefits in preserving the motion at the stabilized segments and limiting the hypermobility at the adjacent segments compared with fusion method. Dynesys stabilization represented a complementary choice in the treatment of degenerative spinal lumbar disease with or without grade I spondylolisthesis.

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Section: Discussionmentioning

confidence: 99%

Section: Study Searchmentioning

confidence: 99%

Section: Clinical Outcomes At Nal Follow-upmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Radiographic and Clinical Outcomes of Dynesys Dynamic Stabilization Versus Instrumented Fusion for Degenerative Lumbar Spine Diseases With a Minimum Follow-Up Period of 2 Years: A Meta-Analysis

Zhou

Zhang

et al. 2020

Preprint

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Biomechanical Evaluation of Rigid Interspinous Process Fixation Combined With Lumbar Interbody Fusion Using Hybrid Testing Protocol

Fan

Zhang

et al. 2023

Journal of Biomechanical Engineering

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Rigid interspinous process fixation (RIPF) has been recently discussed as an alternative to pedicle screw fixation (PSF) for reducing trauma in lumbar interbody fusion (LIF) surgery. This study aimed to investigate biomechanics of the lumbar spine with RIPF, and also to compare biomechanical differences between two postoperative stages (before and after bony fusion). Based on an intact finite-element model of lumbosacral spine, the models of single-level LIF with RIPF or conventional PSF were developed and were computed for biomechanical responses to the moments of four physiological motions using hybrid testing protocol. It was found that compared with PSF, range of motion (ROM), intradiscal pressure (IDP), and facet joint forces (FJF) at adjacent segments of surgical level for RIPF were decreased by up to 8.4%,2.3%and16.8%, but ROM and endplate stress at surgical segment were increased by up to 285.3%and174.3%. The results of comparison between lumbar spine with RIPF before and after bony fusion showed that ROM and endplate stress at surgical segment were decreased by up to 62.6%and40.4%, when achieved to bony fusion. These findings suggest that lumbar spine with RIPF as compared to PSF has potential to decrease the risk of adjacent segment degeneration but might have lower stability of surgical segment and an increased risk of cage subsidence; When achieved bony fusion, it might be helpful for the lumbar spine with RIPF in increasing stability of surgical segment and reducing failure of bone contact with cage.

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Postoperative Management Strategy of Surgical Site Infection following Lumbar Dynesys Dynamic Internal Fixation

Liu

Luo

Zhao

et al. 2021

Pain Research and Management

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Aim. To research the incidence of surgical site infection (SSI) following lumbar Dynesys dynamic internal fixation and its management strategy. Methods. We retrospectively analyzed all cases of lumbar Dynesys dynamic internal fixation performed from January 2010 to December 2019, and the data from patients with SSI were collected. The observational indicators included the incidence of SSI, general information of the patients, surgical details, inflammatory indicators, pathogenic bacteria, and treatment. SSI was defined as both early infection and delayed infection, and the cases were divided into Groups A and B, respectively. The relevant indicators and treatment were compared between the two groups. Results. A total of 1125 cases of lumbar Dynesys dynamic internal fixation were followed up. Twenty-five cases of SSI occurred, and the incidence of SSI was 2.22% (25/1125). There were 14 cases of early infection (1.24%) and 11 cases of delayed infection (0.98%). Fourteen cases of early infection occurred 12.3 ± 8.3 days postoperatively (3–30), and 11 cases of delayed infection occurred 33.3 ± 18.9 months postoperatively (3–62). The inflammatory indicators of Group A were significantly higher than those of Group B (all P < 0.05 ), except for procalcitonin. The main infection site in Group A was located on the skin and subcutaneous tissue and around the internal instrument, while the main infection site in Group B was around the internal instrument. The main treatment for Group A was debridement and implant replacement, and the main treatment for Group B was implant removal. Summary. The incidence of SSI following lumbar Dynesys dynamic internal fixation was 2.22%, the incidence of early SSI was 1.24%, and the incidence of delayed SSI was 0.98%. If the main infection site of early infection is in the incision, debridement should be the main treatment method; if the infection site is around the internal fixation, implant replacement is recommended on the basis of debridement. Once delayed infection is diagnosed, implant removal is suggested.

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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

Cited by 9 publications

References 28 publications

Radiographic and Clinical Outcomes of Dynesys Dynamic Stabilization Versus Instrumented Fusion for Degenerative Lumbar Spine Diseases With a Minimum Follow-Up Period of 2 Years: A Meta-Analysis

Radiographic and Clinical Outcomes of Dynesys Dynamic Stabilization Versus Instrumented Fusion for Degenerative Lumbar Spine Diseases With a Minimum Follow-Up Period of 2 Years: A Meta-Analysis

Biomechanical Evaluation of Rigid Interspinous Process Fixation Combined With Lumbar Interbody Fusion Using Hybrid Testing Protocol

Postoperative Management Strategy of Surgical Site Infection following Lumbar Dynesys Dynamic Internal Fixation

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