Top

International Orthopaedics

Published in:

01-06-2016 | Original Paper

Interspinous dynamic stabilization adjacent to fusion versus double-segment fusion for treatment of lumbar degenerative disease with a minimum follow-up of three years

Authors: Xiao-Long Chen, Li Guan, Yu-Zeng Liu, Jin-Cai Yang, Wen-Long Wang, Yong Hai

Published in: International Orthopaedics | Issue 6/2016

Abstract

Purpose

The aim of this study was to assess the outcome of symptomatic lumbar degenerative disease treated with topping-off technique (Coflex^™ combined with fusion) and compare two-segment fusion at mid-long term follow-up; and find out whether the topping-off technique can reduce the rate of adjacent segment degeneration (ASD) after fusion.

Methods

One hundred and fifty-four consecutive patients who received topping-off surgery (76 patients) and two-segment fusion surgery (88 patients) from March 2009 to March 2012 were studied. All patients included in the analysis had a minimum of three years of follow-up. Radiographic and clinical outcomes between the two groups were compared. A logistic regression analysis was used to analyze risk factors for developing radiographic ASD.

Results

Significant differences in clinical outcomes were observed between these two groups at three post-operative years (all, p < 0.05). Compared with the fusion group, the topping-off group showed preserved mobility at the Coflex^™ level (p = 0.000), which is associated with less blood loss (p = 0.000), shorter duration of surgery (p = 0.000) and lower incidence of ASD (Chi-square test, rate topping-off vs fusion = 13.2 vs 26.1 %, p = 0.039). There were no differences in complications between the two groups.

Conclusion

Mid-long term follow-up efficacy and safety between topping-off and fusion were similar, while topping-off reduced the rate of ASD. Under strict indications, topping-off surgery is an acceptable alternative to fusion surgery for the treatment of two-segment lumbar disease.

Available only for authorised users

Hilibrand AS, Robbins M (2004) Adjacent segment degeneration and adjacent segment disease: the consequences of spinal fusion? Spine J 4:S190–S194. doi:10.1016/j.spinee.2004.07.007 CrossRef

Kumar M, Baklanov A, Chopin D (2001) Correlation between sagittal plane changes and adjacent segment degeneration following lumbar spine fusion. Eur Spine J 10:314–319. doi:10.1007/s005860000239 CrossRefPubMedPubMedCentral

Rahm M, Hall B (1996) Adjacent-segment degeneration after lumbar fusion with instrumentation: a retrospective study. J Spinal Disord 9:392–400CrossRefPubMed

Nakashima H, Kawakami N, Tsuji T, Ohara T, Suzuki Y, Saito T, Nohara A, Tauchi R, Ohta K, Hamajima N, Imagama S (2015) Adjacent segment disease after posterior lumbar interbody fusion. Spine 40:E831–E841. doi:10.1097/BRS.0000000000000917 CrossRefPubMed

Masevnin S, Ptashnikov D, Michaylov D, Meng H, Smekalenkov O, Zaborovskii N (2015) Risk factors for adjacent segment disease development after lumbar fusion. Asian Spine J 9:239–244. doi:10.4184/asj.2015.9.2.239 CrossRefPubMedPubMedCentral

Aota Y, Kumano K, Hirabayashi S (1995) Postfusion instability at the adjacent segments after rigid pedicle screw fixation for degenerative lumbar spinal disorders. J Spinal Disord 8:464–473. doi:10.1097/00024720-199512000-00006 CrossRefPubMed

Okuda S, Iwasaki M, Miyauchi A, Aono H, Morita M, Yamamoto T (2004) Risk factors for adjacent segment degeneration after PLIF. Spine 29:1535–1540. doi:10.1097/01.BRS.0000131417.93637.9D CrossRefPubMed

Park P, Garton HJ, Gala VC, Hoff JT, McGillicuddy JE (2004) Adjacent segment disease after lumbar or lumbosacral fusion: review of the literature. Spine 29:1938–1944. doi:10.1097/01.brs.0000137069.88904.03 CrossRefPubMed

Schilling C, Pfeiffer M, Grupp TM, Blömer W, Rohlmann A (2014) The effect of design parameters of interspinous implants on kinematics and load bearing: an in vitro study. Eur Spine J 23:762–771. doi:10.1007/s00586-014-3237-7 CrossRefPubMedPubMedCentral

10.

Sengupta DK (2004) Dynamic stabilization devices in the treatment of low back pain. Orthop Clin North Am 35:43–56. doi:10.1016/S0030-5898(03)00087-7 CrossRefPubMed

11.

Zhou Z, Xia P, Zhao X, Fang X, Zhao F, Fan S (2012) Can posterior dynamic stabilization reduce the risk of adjacent segment deterioration? Turk Neurosurg 23:579–589. doi:10.5137/1019-5149.JTN.6573-12.1

12.

Bae HW, Musacchio MJ, Lauryssen C, Maislin G, Leary S (2015) Therapeutic sustainability and durability of coflex interlaminar stabilization after decompression for lumbar spinal stenosis: a four year assessment. Int J Spine Surg 15:S98–S99. doi:10.1016/j.spinee.2015.07.044

13.

Davis RJ, Errico TJ, Bae H, Auerbach JD (2013) Decompression and coflex interlaminar stabilization compared with decompression and instrumented spinal fusion for spinal stenosis and low-grade degenerative spondylolisthesis: two-year results from the prospective, randomized, multicenter, food and drug administration investigational device exemption trial. Spine 38:1529–1539. doi:10.1097/BRS.0b013e31829a6d0a CrossRefPubMed

14.

Kong C, Lu S, Hai Y, Zang L (2015) Biomechanical effect of interspinous dynamic stabilization adjacent to single-level fusion on range of motion of the transition segment and the adjacent segment. Clin Biomech 30:355–359. doi:10.1016/j.clinbiomech.2015.02.012 CrossRef

15.

Liu XK, Liu YJ, Lian XF, Xu JG (2015) Magnetic resonance imaging on disc degeneration changes after implantation of an interspinous spacer and fusion of the adjacent segment. Int J Clin Exp Med 8:6097–6102PubMedPubMedCentral

16.

Pfirrmann CWA, Metzdorf A, Zanetti M, Hodler J, Boos N (2001) Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976) 26:1873–1878. doi:10.1097/00007632-200109010-00011 CrossRef

17.

Imagama S, Kawakami N, Kanemura T, Matsubara Y, Tsuji T, Ohara T, Katayama Y, Ishiguro N (2013) Radiographic adjacent segment degeneration at five years after L4/5 posterior lumbar interbody fusion with pedicle screw instrumentation: evaluation by computed tomography and annual screening with magnetic resonance imaging. J Spinal Disord Tech. doi:10.1097/BSD.0b013e31828aec78

18.

Siewe J, Bredow J, Oppermann J, Koy T, Delank S, Knoell P, Eysel P, Sobottke R, Zarghooni K, Röllinghoff M (2014) Evaluation of efficacy of a new hybrid fusion device: a randomized, two-centre controlled trial. BMC Musculoskelet Disord 15. 10.1186/1471-2474-15-294

19.

Kumar N, Shah SM, Ng YH, Pannierselvam VK, Dasde S, Shen L (2014) Role of coflex as an adjunct to decompression for symptomatic lumbar spinal stenosis. Asian Spine J 8:161–169. doi:10.4184/asj.2014.8.2.161 CrossRefPubMedPubMedCentral

20.

Zhu Z, Liu C, Wang K, Zhou J, Wang J, Zhu Y, Liu H (2015) Topping-off technique prevents aggravation of degeneration of adjacent segment fusion revealed by retrospective and finite element biomechanical analysis. J Orthop Surg Res 10:10. doi:10.1186/s13018-014-0142-z CrossRefPubMedPubMedCentral

21.

Aunoble S, Meyrat R, Al Sawad Y, Tournier C, Leijssen P, Le Huec J (2010) Hybrid construct for two levels disc disease in lumbar spine. Eur Spine J 19:290–296. doi:10.1007/s00586-009-1182-7 CrossRefPubMed

22.

Celik H, Derincek A, Koksal I (2011) Surgical treatment of the spinal stenosis with an interspinous distraction device: do we really restore the foraminal height? Turk Neurosurg 22:50–54. doi:10.5137/1019-5149.JTN.4681-11.2

23.

Yu S, Yen C, Wu C, Kao F, Kao Y, Tu Y (2012) Radiographic and clinical results of posterior dynamic stabilization for the treatment of multisegment degenerative disc disease with a minimum follow-up of 3 years. Arch Orthop Trauma Surg 132:583–589. doi:10.1007/s00402-012-1460-4 CrossRefPubMed

24.

Zang L, Du P, Hai Y, Su QJ, Lu SB, Liu T (2013) Device-related complications of the coflex interspinous process implant for the lumbar spine. Global Spine J 04:2517–2522. doi:10.1055/s-0034-1376687

Title: Interspinous dynamic stabilization adjacent to fusion versus double-segment fusion for treatment of lumbar degenerative disease with a minimum follow-up of three years
Authors: Xiao-Long Chen
Li Guan
Yu-Zeng Liu
Jin-Cai Yang
Wen-Long Wang
Yong Hai
Publication date: 01-06-2016
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 6/2016
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-016-3199-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Interspinous dynamic stabilization adjacent to fusion versus double-segment fusion for treatment of lumbar degenerative disease with a minimum follow-up of three years

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 6/2016

Effect of the percutaneous pedicle screw fixation at the fractured vertebra on the treatment of thoracolumbar fractures

Microsurgery or open cervical foraminotomy for cervical radiculopathy? A systematic review

Comment on Wang et al.: One-stage posterior focus debridement, interbody graft using titanium mesh cages, posterior instrumentation and fusion in the surgical treatment of lumbo-sacral spinal tuberculosis in the aged

A comparison of three different surgical procedures in the treatment of type A thoracolumbar fractures: a randomized controlled trial

Limited long-segment fusion for degenerative lower lumbar scoliosis: a special kind of scoliosis

Paediatric cervical spine injures. Nineteen years experience of a single centre