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Clinical Orthopaedics and Related Research®

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01-07-2012 | Symposium: Retrieval Studies

Which Radiographic Parameters Are Linked to Failure of a Dynamic Spinal Implant?

Authors: Eike Hoff, MD, Patrick Strube, MD, Antonius Rohlmann, PhD, Christian Groß, MD, Michael Putzier, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 7/2012

Abstract

Background

Knowledge about factors leading to failure of posterior dynamic stabilization implants is essential to design future implants and establish surgical indications. Therefore, we analyzed an implant for single-level or hybrid configuration (adjacent to spondylodesis), which was recalled due to high failure rates.

Questions/purposes

We asked: (1) Were postoperative radiographic changes linked to implant failure? (2) Were radiographic parameters different between the two configurations? And (3) was implant failure related to inferior clinical scores?

Methods

The implant was used in 18 patients with lumbar single-level spinal stenosis or with (recurrent) disc herniation and concurrent degenerative disc disease and in 22 patients with an initially degenerated segment adjacent and superior to a fusion site. We prospectively obtained preoperative and postoperative (immediate, 6-, 12- and 24-month) clinical and radiographic evaluations; 37 of the 40 patients completed the 24-month followup. Using plain and extension-flexion radiographs, we compared implant failure rates and their association with postoperative implant translation, anterior and posterior disc height, and ROM for each configuration and between configurations. We assessed associations between clinical scores (VAS pain scores for back and leg, Oswestry Disability Index) and implant failure.

Results

Implant failure occurred in 10 of the 37 implants and corresponded to greater posterior disc height (single-level only) and implant translation. Adjacent-segment ROM increases and posterior disc height decreases over time were greater with the hybrid configuration. Implant failure rate related to higher Oswestry Disability Index (single-level only) and higher back pain scores.

Conclusions

Implant translation is associated with failure likely due to insufficient resistance to shear forces. Load transfer may cause progressive degeneration in the dynamic and adjacent segments, especially in the hybrid configuration.

Level of Evidence

Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Bono CM, Kadaba M, Vaccaro AR. Posterior pedicle fixation-based dynamic stabilization devices for the treatment of degenerative diseases of the lumbar spine. J Spinal Disord Tech. 2009;22:376–383.PubMedCrossRef

Bordes-Monmeneu M, Bordes-Garcia V, Rodrigo-Baeza F, Saez D. [System of dynamic neutralization in the lumbar spine: experience on 94 cases] [in Spanish]. Neurocirugia (Asturias, Spain). 2005;16:499–506.

Bothmann M, Kast E, Boldt GJ, Oberle J. Dynesys fixation for lumbar spine degeneration. Neurosurg Rev. 2008;31:189–196.PubMedCrossRef

Cho KJ, Suk SI, Park SR, Kim JH, Kim SS, Choi WK, Lee KY, Lee SR. Complications in posterior fusion and instrumentation for degenerative lumbar scoliosis. Spine (Phila Pa 1976). 2007;32:2232–2237. CrossRef

Chou WY, Hsu CJ, Chang WN, Wong CY. Adjacent segment degeneration after lumbar spinal posterolateral fusion with instrumentation in elderly patients. Arch Orthop Trauma Surg. 2002;122:39–43.PubMed

Chow DH, Luk KD, Evans JH, Leong JC. Effects of short anterior lumbar interbody fusion on biomechanics of neighboring unfused segments. Spine (Phila Pa 1976). 1996;21:549–555.CrossRef

Delamarter RB, Maxwell J, Davis R, Sherman J, Welch W. Nonfusion application of the Dynesys system in the lumbar spine: early results from the IDE Multicenter Trial. Spine J. 2006;6(suppl):77S.CrossRef

Dupuis PR, Yong-Hing K, Cassidy JD, Kirkaldy-Willis WH. Radiologic diagnosis of degenerative lumbar spinal instability. Spine (Phila Pa 1976). 1985;10:262–276.CrossRef

Fairbank TC, Pynsent PB. The Oswestry Disability Index. Spine (Phila Pa 1976). 2000;25:2940–2952.CrossRef

10.

Fujiwara A, Tamai K, Yamato M, An HS, Yoshida H, Saotome K, Kurihashi A. The relationship between facet joint osteoarthritis and disc degeneration of the lumbar spine: an MRI study. Eur Spine J. 1999;8:396–401.PubMedCrossRef

11.

Gerbershagen HU, Lindena G, Korb J, Kramer S. Health-related quality of life in patients with chronic pain in German. Schmerz (Berlin, Germany). 2002;16:271–284.CrossRef

12.

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

13.

Grevitt MP, Gardner AD, Spilsbury J, Shackleford IM, Baskerville R, Pursell LM, Hassaan A, Mulholland RC. The Graf stabilisation system: early results in 50 patients. Eur Spine J. 1995;4:169–175; discussion 135.PubMedCrossRef

14.

Grob D, Benini A, Junge A, Mannion AF. 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 (Phila Pa 1976). 2005;30:324–331.CrossRef

15.

Ha KY, Schendel MJ, Lewis JL, Ogilvie JW. Effect of immobilization and configuration on lumbar adjacent-segment biomechanics. J Spinal Disord. 1993;6:99–105.PubMedCrossRef

16.

Hadlow SV, Fagan AB, Hillier TM, Fraser RD. The Graf ligamentoplasty procedure: comparison with posterolateral fusion in the management of low back pain. Spine (Phila Pa 1976). 1998;23:1172–1179.CrossRef

17.

Hambly MF, Wiltse LL, Raghavan N, Schneiderman G, Koenig C. The transition zone above a lumbosacral fusion. Spine (Phila Pa 1976). 1998;23:1785–1792. CrossRef

18.

Kanayama M, Hashimoto T, Shigenobu K, Togawa D, Oha F. A minimum 10-year follow-up of posterior dynamic stabilization using Graf artificial ligament. Spine (Phila Pa 1976). 2007;32:1992–1996; discussion 1997.CrossRef

19.

Kaner T, Sasani M, Oktenoglu T, Cosar M, Ozer AF. Utilizing dynamic rods with dynamic screws in the surgical treatment of chronic instability: a prospective clinical study. Turk Neurosurg. 2009;19:319–326.PubMed

20.

Kaner T, Sasani M, Oktenoglu T, Ozer AF. Dynamic stabilization of the spine: a new classification system. Turk Neurosurg. 2010;20:205–215.PubMed

21.

Kumar MN, Baklanov A, Chopin D. Correlation between sagittal plane changes and adjacent segment degeneration following lumbar spine fusion. Eur Spine J. 2001;10:314–319.PubMedCrossRef

22.

Kumar MN, Jacquot F, Hall H. Long-term follow-up of functional outcomes and radiographic changes at adjacent levels following lumbar spine fusion for degenerative disc disease. Eur Spine J. 2001;10:309–313.PubMedCrossRef

23.

Leone A, Cassar-Pullicino VN, Guglielmi G, Bonomo L. Degenerative lumbar intervertebral instability: what is it and how does imaging contribute? Skeletal Radiol. 2009;38:529–533.PubMedCrossRef

24.

Leone A, Guglielmi G, Cassar-Pullicino VN, Bonomo L. Lumbar intervertebral instability: a review. Radiology. 2007;245:62–77.PubMedCrossRef

25.

Maleci A, Sambale RD, Schiavone M, Lamp F, Ozer F, von Strempel A. Nonfusion stabilization of the degenerative lumbar spine. J Neurosurg Spine. 2011;15:151–158.PubMedCrossRef

26.

Maserati MB, Tormenti MJ, Panczykowski DM, Bonfield CM, Gerszten PC. The use of a hybrid dynamic stabilization and fusion system in the lumbar spine: preliminary experience. Neurosurg Focus. 2010;28:E2.PubMedCrossRef

27.

Meyerding HW. Spondylolisthesis. J Bone Joint Surg Br. 1931;13:39–48.

28.

Miyakoshi N, Abe E, Shimada Y, Okuyama K, Suzuki T, Sato K. Outcome of one-level posterior lumbar interbody fusion for spondylolisthesis and postoperative intervertebral disc degeneration adjacent to the fusion. Spine (Phila Pa 1976). 2000;25:1837–1842.CrossRef

29.

Modic MT, Steinberg PM, Ross JS, Masaryk TJ, Carter JR. Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology. 1988;166:193–199.PubMed

30.

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

31.

Park P, Garton HJ, Gala VC, Hoff JT, McGillicuddy JE. Adjacent segment disease after lumbar or lumbosacral fusion: review of the literature. Spine (Phila Pa 1976). 2004;29:1938–1944.CrossRef

32.

Penta M, Sandhu A, Fraser RD. Magnetic resonance imaging assessment of disc degeneration 10 years after anterior lumbar interbody fusion. Spine (Phila Pa 1976). 1995;20:743–747.CrossRef

33.

Pihlajamaki H, Bostman O, Ruuskanen M, Myllynen P, Kinnunen J, Karaharju E. Posterolateral lumbosacral fusion with transpedicular fixation: 63 consecutive cases followed for 4 (2–6) years. Acta Orthop Scand. 1996;67:63–68.PubMedCrossRef

34.

Plev D, Sutcliffe JC. Outcome and complications using a dynamic neutralization and stabilization pedicle screw system (DYNESYS): is this a “soft fusion”? Spine J. 2005;5:S141–S142.CrossRef

35.

Putzier M, Hoff E, Tohtz S, Gross C, Perka C, Strube P. Dynamic stabilization adjacent to single-level fusion. Part II. No clinical benefit for asymptomatic, initially degenerated adjacent segments after 6 years follow-up. Eur Spine J. 2010;19:2181–2189.PubMedCrossRef

36.

Putzier M, Schneider SV, Funk J, Perka C. [Application of a dynamic pedicle screw system (DYNESYS) for lumbar segmental degenerations—comparison of clinical and radiological results for different indications] [in German]. Z Orthop Ihre Grenzgeb. 2004;142:166–173.PubMedCrossRef

37.

Putzier M, Schneider SV, Funk JF, Tohtz SW, Perka C. The surgical treatment of the lumbar disc prolapse: nucleotomy with additional transpedicular dynamic stabilization versus nucleotomy alone. Spine (Phila Pa 1976). 2005;30:E109–E114.CrossRef

38.

Rahm MD, Hall BB. Adjacent-segment degeneration after lumbar fusion with instrumentation: a retrospective study. J Spinal Disord. 1996;9:392–400.PubMedCrossRef

39.

Rohlmann A, Burra NK, Zander T, Bergmann G. Comparison of the effects of bilateral posterior dynamic and rigid fixation devices on the loads in the lumbar spine: a finite element analysis. Eur Spine J. 2007;16:1223–1231.PubMedCrossRef

40.

Rohlmann A, Nabil Boustani H, Bergmann G, Zander T. Effect of a pedicle-screw-based motion preservation system on lumbar spine biomechanics: a probabilistic finite element study with subsequent sensitivity analysis. J Biomech. 2010;43:2963–2969.PubMedCrossRef

41.

Rohlmann A, Zander T, Schmidt H, Wilke HJ, Bergmann G. Analysis of the influence of disc degeneration on the mechanical behaviour of a lumbar motion segment using the finite element method. J Biomech. 2006;39:2484–2490.PubMedCrossRef

42.

Ruberte LM, Natarajan RN, Andersson GB. Influence of single-level lumbar degenerative disc disease on the behavior of the adjacent segments—a finite element model study. J Biomech. 2009;42:341–348.PubMedCrossRef

43.

Saxler G, Wedemeyer C, von Knoch M, Render UM, Quint U. [Follow-up study after dynamic and static stabilisation of the lumbar spine] [in German]. Z Orthop Ihre Grenzgeb. 2005;143:92–99.PubMedCrossRef

44.

Schaeren S, Broger I, Jeanneret B. Minimum four-year follow-up of spinal stenosis with degenerative spondylolisthesis treated with decompression and dynamic stabilization. Spine (Phila Pa 1976). 2008;33:E636–E642.CrossRef

45.

Schilling C, Kruger S, Grupp TM, Duda GN, Blomer W, Rohlmann A. The effect of design parameters of dynamic pedicle screw systems on kinematics and load bearing: an in vitro study. Eur Spine J. 2011;20:297–307.PubMedCrossRef

46.

Schlegel JD, Smith JA, Schleusener RL. Lumbar motion segment pathology adjacent to thoracolumbar, lumbar, and lumbosacral fusions. Spine (Phila Pa 1976). 1996;21:970–981.CrossRef

47.

Schmidt H, Heuer F, Wilke HJ. Which axial and bending stiffnesses of posterior implants are required to design a flexible lumbar stabilization system? J Biomech. 2009;42:48–54.PubMedCrossRef

48.

Schnake KJ, Schaeren S, Jeanneret B. Dynamic stabilization in addition to decompression for lumbar spinal stenosis with degenerative spondylolisthesis. Spine (Phila Pa 1976). 2006;31:442–449.CrossRef

49.

Sengupta DK. Dynamic stabilization devices in the treatment of low back pain. Orthop Clin North Am. 2004;35:43–56.PubMedCrossRef

50.

Stoffel M, Behr M, Reinke A, Stuer C, Ringel F, Meyer B. Pedicle screw-based dynamic stabilization of the thoracolumbar spine with the Cosmic-system: a prospective observation. Acta Neurochir (Wien). 2010;152:835–843.CrossRef

51.

Stoll TM, Dubois G, Schwarzenbach O. The dynamic neutralization system for the spine: a multi-center study of a novel non-fusion system. Eur Spine J. 2002;11(suppl 2):S170–S178.PubMed

52.

Strube P, Tohtz S, Hoff E, Gross C, Perka C, Putzier M. Dynamic stabilization adjacent to single-level fusion. Part I. Biomechanical effects on lumbar spinal motion. Eur Spine J. 2010;19:2171–2180.PubMedCrossRef

53.

Wurgler-Hauri CC, Kalbarczyk A, Wiesli M, Landolt H, Fandino J. Dynamic neutralization of the lumbar spine after microsurgical decompression in acquired lumbar spinal stenosis and segmental instability. Spine (Phila Pa 1976). 2008;33:E66–E72.CrossRef

54.

Zander T, Rohlmann A, Burra NK, Bergmann G. Effect of a posterior dynamic implant adjacent to a rigid spinal fixator. Clin Biomech (Bristol, Avon). 2006;21:767–774.CrossRef

Title: Which Radiographic Parameters Are Linked to Failure of a Dynamic Spinal Implant?
Authors: Eike Hoff, MD
Patrick Strube, MD
Antonius Rohlmann, PhD
Christian Groß, MD
Michael Putzier, MD
Publication date: 01-07-2012
Publisher: Springer-Verlag
Published in: Clinical Orthopaedics and Related Research® / Issue 7/2012
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-011-2200-8

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Springer Medicine

Which Radiographic Parameters Are Linked to Failure of a Dynamic Spinal Implant?

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Level of Evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Level of Evidence

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