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01-06-2010 | Ideas and Technical Innovations

Segment-by-segment stabilization for degenerative disc disease: a hybrid technique

Authors: Othmar Schwarzenbach, Nathalie Rohrbach, Ulrich Berlemann

Published in: European Spine Journal | Issue 6/2010

Abstract

Patients with multisegmental degenerative disc disease (DDD) resistant to conservative therapy are typically treated with either fusion or non-fusion surgical techniques. The two techniques can be applied at adjacent levels using Dynesys^® (Zimmer GmbH, Winterthur, Switzerland) implants in a segment-by-segment treatment of multiple level DDD. The objective of this study was to evaluate the clinical and radiological outcome of patients treated using this segment-by-segment application of Dynesys in some levels as a non-fusion device and in other segments in combination with a PLIF as a fusion device. A consecutive case series is reported. The sample included 16 females and 15 males with a mean age of 53.6 years (range 26.3–76.4 years). Mean follow-up time was 39 months (range 24–90 months). Preoperative Oswestry disability index (ODI), back- and leg-pain scores (VAS) were compared to postoperative status. Fusion success and system failure were assessed by an independent reviewer who analyzed AP and lateral X-rays. Back pain improved from 7.3 ± 1.7 to 3.4 ± 2.7 (p < 0.000002), leg pain from 6.0 ± 2.9 to 2.3 ± 2.9 (p < 0.00006), and ODI from 51.6 ± 13.2% to 28.7 ± 18.0% (p < 0.00001). Screw loosening occurred in one of a total of 222 implanted screws (0.45%). The results indicate that segment-by-segment treatment with Dynesys^® in combination with interbody fusion is technically feasible, safe, and effective for the surgical treatment of multilevel DDD.

Battié M, Videman T, Parent E (2004) Lumbar disk degeneration: epidemiology and genetic influences. Spine 29:2679–2690CrossRefPubMed

Benoist M (2003) Natural history of the aging spine. Eur Spine J 12(Suppl 2):S86–S89CrossRefPubMed

Bertagnoli R, Tropiano P, Zigler J, Karg A, Voigt S (2005) Hybrid constructs. Orthop Clin N Am 36:379–388CrossRef

Boden SD, Davis DO, Dina TS, Patronas NJ, Wiesel SW (1990) Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg 72:403–408PubMed

Bono CM, Lee CK (2004) Critical analysis of trends in fusion for degenerative disc disease over the past 20 years. Spine 29:455–463CrossRefPubMed

Bono CM, Lee CK (2005) The influence of subdiagnosis on radiographic and clinical outcomes after lumbar fusion for degenerative disc disorders: an analysis of the literature from two decades. Spine 30:227–234CrossRefPubMed

Boos N, Rieder R, Schade V, Spratt K, Semmer N, Aebi M (1995) Volvo award in clinical sciences. The diagnostic accuracy of magnetic resonance imaging, work perception and psychosocial factors in identifying symptomatic disk herniations. Spine 20:2613–2625CrossRefPubMed

Brislin B, Vaccaro A (2002) Advances in posterior lumbar interbody fusion. Orthop Clin N Am 33:367–374CrossRef

Carragee EJ, Paragioudakis StJ, Khurana S (2000) Lumbar high-intensity zone and discography in subjects without low back problems. Spine 25:2987–2992CrossRefPubMed

10.

Cheng BC, Gordon J, Cheng J, Welch WC (2007) Immediate biomechanical effects of lumbar posterior dynamic stabilization above a circumferential fusion. Spine 32(23):2551–2557CrossRefPubMed

11.

Diwan AD, Parvartaneni H, Cammisa F (2003) Failed degenerative lumbar spine surgery. Orthop Clin N Am 34:309–324CrossRef

12.

Fairbank JCT, Pynsent PB (2000) The Oswestry disability index. Spine 25:2940–2953CrossRefPubMed

13.

Freeman BJC, Licina P, Mehdian SH (2000) Posterior lumbar interbody fusion combined with instrumented postero-lateral fusion: 5-year results in 60 patients. Eur Spine J 9:42–46CrossRefPubMed

14.

Fritzell P, Hagg O, Wessberg P, Nordwall A, Swedish Lumbar Spine Group (2002) Chronic low back pain and fusion: a comparison of three surgical techniques: a prospective multicenter randomized study from the Swedish Lumbar Spine Study Group. Spine 27:1131–1141CrossRefPubMed

15.

Ghiselli G, Wang JC, Bhatia NN, Hsu WK, Dawson EG (2004) Adjacent segment degeneration in the lumbar spine. J Bone Joint Surg Am 86-A(7):1497–1503PubMed

16.

Gillet P (2003) The fate of the adjacent motion segments after lumbar fusion. J Spinal Disord Tech 16(4):338–345PubMed

17.

Glassman S, Gornet MF, Branch C, Polly D, Peloza J (2006) MOS short form 36 and Oswestry disability index outcomes in lumbar fusion: a multicenter experience. Spine J 6:21–26CrossRefPubMed

18.

Greiner-Perth R, Boehm H, Allam Y, Elsaghir H, Franke J (2004) Reoperation rate after instrumented posterior lumbar interbody fusion. Spine 29:2516–2520CrossRefPubMed

19.

Grob D, Benini A, Junge A, Mannion AF (2005) Clinical experience with the Dynesys semirigid fixation system for the lumbar spine: surgical and patient-oriented outcome in 50 cases after an average of 2 years. Spine 30(3):324–331CrossRefPubMed

20.

Guiot BH, Fessler RG (2000) Molecular biology of degenerative disc disease. Neurosurgery 47:1034–1040CrossRefPubMed

21.

Haig AJ (2002) Paraspinal denervation and the spinal degenerative cascade. Spine J 2:372–380CrossRefPubMed

22.

Hioki A, Miyamoto K, Kodama H, Hosoe H, Nishimoto H (2005) Two-level posterior lumbar interbody fusion for degenerative disc disease: improved clinical outcome with restoration of lumbar lordosis. Spine J 5:600–607CrossRefPubMed

23.

Jarvik J, Hollingworth W, Haegerty P, Haynor DR, Deyo RA (2001) The longitudinal assessment of imaging and disability of the back (LAIDBack) study: baseline data. Spine 26:1158–1166CrossRefPubMed

24.

Jayakumar P, Nnadi C, Saifuddin A, MacSweeney E, Casey A (2006) Dynamic degenerative lumbar spondylolisthesis: diagnosis with axial loaded magnetic resonance imaging. Spine 31:E298–E301CrossRefPubMed

25.

Junghanns H (1968) Die gesunde und die kranke Wirbelsäule in Röntgenbild und Klinik. Thieme, Stuttgart

26.

Kang CH, Shin MJ, Kim SM, Lee SH, Lee CS (2007) MRI of paraspinal muscles in lumbar degenerative kyphosis patients and control patients with chronic low back pain. Clin Radiol 62:479–486CrossRefPubMed

27.

Keller TS, Harrison DE, Colloca CJ, Harrison DD, Janik TJ (2003) Prediction of osteoporotic spinal deformity. Spine 28:455–462CrossRefPubMed

28.

Kim KT, Lee SH, Lee YH, Bae SC, Suk KS (2006) Clinical outcomes of 3 fusion methods through the posterior approach in the lumbar spine. Spine 31:1351–1357CrossRefPubMed

29.

Kirkaldy-Willis WH, Farfan HF (1982) Instability of the lumbar spine. Clin Orthop 165:110–123PubMed

30.

Kjaer P, Ch Leboeuf-Yde, Korsholm L, Sorensen JS, Bendix T (2005) Magnetic resonance imaging and low back pain in adults: a diagnostic imaging study of 40-year-old men and women. Spine 30:1173–1180CrossRefPubMed

31.

Lee C, Dorcil J, Radomisli TE (2004) Nonunion of the spine: a review. Clin Orthop 419:71–75CrossRefPubMed

32.

Madan SS, Boeree NR (2003) Comparison of instrumented anterior interbody fusion with instrumented circumferential lumbar fusion. Eur Spine J 2:567–575CrossRef

33.

Maghout-Jurati S, Franklin GM, Mirza SK, Wickizer TM, Fulton-Kehoe D (2006) Lumbar fusion outcomes in Washington State workers’ compensation. Spine 31:2715–2723CrossRef

34.

Masui T, Yukawa Y, Nakamura S, Kajino G, Matsubara Y, Kshiguro N (2005) Natural history of patients with lumbar disc herniation observed by magnetic resonance imaging for minimum 7 years. J Spinal Disord Tech 18:121–126CrossRefPubMed

35.

Niosi CA, Zhu QA, Wilson DC, Keynan O, Wilson DR, Oxland TR (2006) Biomechanical characterization of the three-dimensional kinematic behaviour of the Dynesys dynamic stabilization system: an in vitro study. Eur Spine J 15(6):913–922CrossRefPubMed

36.

Ohlin A, Karlsson M, Düppe H, Hasserius R, Redlund-Johnell I (1994) Complications after transpedicular stabilization of the spine. A survivorship analysis of 163 cases. Spine 19(24):2774–2779CrossRefPubMed

37.

Pappou IP, Cammisa FP, Girardi FP (2007) Correlation of end plate shape on MRI and disc degeneration in surgically treated patients with degenerative disc disease and herniated nucleus pulposus. Spine J 7:32–38CrossRefPubMed

38.

Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N (2001) Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine 26(17):1873–1878CrossRefPubMed

39.

Podichetty VK (2007) The aging spine: the role of inflammatory mediators in intervertebral disc degeneration. Cell Mol Biol 53:4–18PubMed

40.

Putzier M, Schneider SV, Funk JF, Tohtz SW, Perka C (2005) The surgical treatment of the lumbar disc prolapse: nucleotomy with additional transpedicular dynamic stabilization versus nucleotomy alone. Spine 30(5):E109–E114CrossRefPubMed

41.

Schaeren S, Broger I, Jeanneret B (2008) Minimum four-year follow-up of spinal stenosis with degenerative spondylolisthesis treated with decompression and dynamic stabilization. Spine 33(18):E636–E642CrossRefPubMed

42.

Schmoelz W, Huber JF, Nydegger T, Claes L, Wilke HJ (2003) Dynamic stabilization of the lumbar spine and its effects on adjacent segments: an in vitro experiment. J Spinal Disord Tech 16(4):418–423PubMed

43.

Schnake KJ, Schaeren S, Jeanneret B (2006) Dynamic stabilization in addition to decompression for lumbar spinal stenosis with degenerative spondylolisthesis. Spine 31(4):442–449CrossRefPubMed

44.

Schwarzenbach O, Berlemann U, Stoll TM, Dubois G (2005) Posterior dynamic stabilization systems: Dynesys. Orthop Clin N Am 36:363–372CrossRef

45.

Solovieva S, Lohiniva J, Leino-Arjas P, Raininko R, Luoma K, Ala-Kokko L, Riihimaki H (2006) Intervertebral disc degeneration in relation to the COL9A3 and the IL-1β gene polymorphisms. Eur Spine J 15:613–619CrossRefPubMed

46.

Stoll TM, Dubois G, Schwarzenbach O (2002) The dynamic neutralization system for the spine: a multi-center study of a novel non-fusion system. Eur Spine J 11(Suppl 2):S170–S178PubMed

47.

Suk S, Lee CK, Kim WJ, Lee JH, Cho KJ (1997) Adding posterior lumbar interbody fusion to pedicle screw fixation and posterolateral fusion after decompression in spondylolytic spondylolisthesis. Spine 22:210–219CrossRefPubMed

48.

Symmons DP, van Hemert AM, Vandenbroucke JP, Valkenburg HA (1991) A longitudinal study of back pain and radiological changes in the lumbar spines of middle aged women. II. Radiological findings. Ann Rheum Dis 50:162–166CrossRefPubMed

49.

Videman T, Battie MC, Ripatti S, Gill K, Manninen H, Kaprio J (2006) Determinants of the progression in lumbar degeneration: a 5-year follow-up of adult male monozygotic twins. Spine 31(6):671–678CrossRefPubMed

50.

Vishteh AG, Crawford NR, Chamberlain RH, Thramann JJ, Park SC (2005) Biomechanical comparison of anterior versus posterior lumbar threaded interbody fusion cages. Spine 30:302–310CrossRefPubMed

51.

Welch WC, Cheng BC, Awad TE, Davis R, Maxwell JH, Delamarter R, Wingate JK, Sherman J, Macenski MM (2007) Clinical outcomes of the Dynesys dynamic neutralization system: 1-year preliminary results. Neurosurg Focus 22(1):E8CrossRefPubMed

52.

White AA, Panjabi MM (1978) The basic kinematics of the human spine: a review of past and current knowledge. Spine 3:12–20CrossRefPubMed

53.

Wimmer C, Gluch H, Krismer M, Ogon M, Jesenko R (1997) AP-translation in the proximal disc adjacent to lumbar spine fusion. A retrospective comparison of mono- and polysegmental fusion in 120 patients. Acta Orthop Scand 68(3):269–272CrossRefPubMed

54.

Zanoli G, Strömqvist B, Jönsson B (2001) Visual analog scales for interpretation of back and leg pain intensity in patients operated for degenerative lumbar spine disorders. Spine 26:2375–2380CrossRefPubMed

Title: Segment-by-segment stabilization for degenerative disc disease: a hybrid technique
Authors: Othmar Schwarzenbach
Nathalie Rohrbach
Ulrich Berlemann
Publication date: 01-06-2010
Publisher: Springer-Verlag
Published in: European Spine Journal / Issue 6/2010
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-010-1282-4

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Segment-by-segment stabilization for degenerative disc disease: a hybrid technique

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