Short-term effects of a dynamic neutralization system (Dynesys) for multi-segmental lumbar disc herniation

Wang, Qi; Liu, Jun; Shi, Ying; Chen, Yu; Yu, Hailong; Ma, Junxiong; Ren, Weijian; Yang, Huifeng; Wang, Hongwei; Xiang, Liangbi

doi:10.1007/s00586-015-4307-1

Cited by 17 publications

(35 citation statements)

References 34 publications

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“…However, most of these studies were short-term case reports; comparative studies with PLIF are lacking. 20 , 21 Through its retrospective case-control design, the present study allowed for comparison of the clinical effects and radiographic characteristics of Dynesys stabilization versus PLIF for the treatment of multisegmental lumbar degenerative disease. In addition, the average follow-up duration was more than 46 months.…”

Section: Discussionmentioning

confidence: 99%

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

Pang

Jiang

2017

J Int Med Res

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ObjectiveTo compare the medium-term clinical and radiographic outcomes of Dynesys dynamic stabilization and posterior lumbar interbody fusion (PLIF) for treatment of multisegmental lumbar degenerative disease.MethodsFifty-seven patients with multisegmental lumbar degenerative disease underwent Dynesys stabilization (n = 26) or PLIF (n = 31) from December 2008 to February 2010. The mean follow-up period was 50.3 (range, 46–65) months. Clinical outcomes were evaluated using a visual analogue scale (VAS) and the Oswestry disability index (ODI). Radiographic evaluations included disc height and range of motion (ROM) of the operative segments and proximal adjacent segment on lumbar flexion-extension X-rays. The intervertebral disc signal change was defined by magnetic resonance imaging, and disc degeneration was classified by the Pfirrmann grade.ResultsThe clinical outcomes including the VAS score and ODI were significantly improved in both groups at 3 months and the final follow-up, but the difference between the two was not significant. At the final follow-up, the disc height of stabilized segments in both groups was significantly increased; the increase was more notable in the Dynesys than PLIF group. The ROM of stabilized segments at the final follow-up decreased from 6.20° to 2.76° and 6.56° to 0.00° in the Dynesys and PLIF groups, respectively. There was no distinct change in the height of the proximal adjacent segment in the two groups. The ROM of the proximal adjacent segment in both groups increased significantly at the final follow-up; the change was significantly greater in the PLIF than Dynesys group. Only one case of adjacent segment degeneration occurred in the PLIF group, and this patient underwent a second operation.ConclusionsBoth Dynesys stabilization and PLIF can improve the clinical and radiographic outcomes of multisegmental lumbar degenerative disease. Compared with PLIF, Dynesys stabilization can maintain the mobility of the stabilized segments with less influence on the proximal adjacent segment and may help to prevent the occurrence of adjacent segment degeneration. Dynesys is reliable for the treatment of multisegmental lumbar degenerative disease at the medium-term follow-up.

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Section: Discussionmentioning

confidence: 99%

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

Pang

Jiang

2017

J Int Med Res

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“…In the past 20 years, the range of spine stabilization therapies has been augmented by the advent of motion preservation systems that attempt to decrease the incidence of ASD after rigid fixation [ 17 ]. These systems have shown satisfactory results in terms of pain relief, safety, quality of life, and motion preservation [ 18 - 20 ]. By preserving physiologic motion of the spine, dynamic fixators mitigate hypermobility and the disruptive biomechanical forces observed in adjacent segments after arthrodesis [ 6 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…These systems have shown satisfactory results in terms of pain relief, safety, quality of life, and motion preservation [ 18 - 20 ]. By preserving physiologic motion of the spine, dynamic fixators mitigate hypermobility and the disruptive biomechanical forces observed in adjacent segments after arthrodesis [ 6 , 18 ]. Despite these advantages, the role of non-fusion systems in the context of ASD remains ambiguous.…”

Section: Discussionmentioning

confidence: 99%

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

Kashkoush¹,

Agarwal²,

Paschel³

et al. 2016

Cureus

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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.

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“…Low back pain is the world's largest cause of years lost to disability, but it usually has no objective diagnosis or known mechanism [1,2]. Aberrant intervertebral motion in the lumbar spine as measured in vivo using standardised quantitative fluoroscopic imaging protocols (QF) has been linked to nonspecific low back pain (NSLBP) as a biomarker [3][4][5], and many interventions exist to influence it [6][7][8]. This holds out the prospect of applying lumbar motion parameters as personalised biomarkers for the diagnosis of otherwise 'nonspecific' low back pain.…”

Section: Introductionmentioning

confidence: 99%

Intrasubject repeatability of in vivo intervertebral motion parameters using quantitative fluoroscopy

2018

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Purpose In vivo quantification of intervertebral motion through imaging has progressed to a point where biomarkers for low back pain are emerging. This makes possible deeper study of the condition's biometrics. However, the measurement of change over time involves error. The purpose of this prospective investigation is to determine the intrasubject repeatability of six in vivo intervertebral motion parameters using quantitative fluoroscopy. Methods Intrasubject reliability (ICC) and minimal detectable change (MDC) of baseline to 6-week follow-up measurements were calculated for six lumbar spine intervertebral motion parameters in 109 healthy volunteers. A standardised quantitative fluoroscopy (QF) protocol was used to provide measurements in the coronal and sagittal planes using both passive recumbent and active weight-bearing motion. Parameters were: intervertebral range of motion (IV-RoM), laxity, motion sharing inequality (MSI), motion sharing variability (MSV), flexion translation and anterior disc height change during flexion. Results The best overall intrasubject reliability (ICC) and agreement (MDC) were for disc height (ICC 0.89, MDC 43%) and IV-RoM (ICC 0.96, MDC 60%), and the worst for MSV (ICC 0.04, MDC 408%). Laxity, MSI and translation had acceptable reliability (most ICCs > 0.60), but not agreement (MDC > 85%). Conclusion Disc height and IV-RoM measurement using QF could be considered for randomised trials, while laxity, MSI and translation could be considered for moderators, correlates or mediators of patient-reported outcomes. MSV had both poor reliability and agreement over 6 weeks. Graphical abstract These slides can be retrieved under Electronic Supplementary Material.

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Short-term effects of a dynamic neutralization system (Dynesys) for multi-segmental lumbar disc herniation

Abstract: The non-fusion fixation system Dynesys is safe and effective regarding short-term curative effects for the treatment of ms-LDH.

Cited by 17 publications

References 34 publications

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

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

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

Intrasubject repeatability of in vivo intervertebral motion parameters using quantitative fluoroscopy

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