Top

Journal of Orthopaedic Surgery and Research

Published in:

Open Access 01-12-2022 | Degenerative Disease | Systematic review

Effects of posterior lumbar nonfusion surgery with isobar devices versus posterior lumbar interbody fusion surgery on clinical and radiological features in patients with lumbar degenerative diseases: a meta-analysis

Authors: Jianbin Guan, Tao Liu, Wenhao Li, He Zhao, Kaitan Yang, Chuanhong Li, Ningning Feng, Guozheng Jiang, Yongdong Yang, Xing Yu

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2022

Abstract

Purpose

The aim of this study was to systematically evaluate the efficacy of posterior lumbar isobar nonfusion with isobar devices versus posterior lumbar interbody fusion (PLIF) in the treatment of patients with lumbar degenerative diseases (LDDs).

Materials and method

We performed a literature review and meta-analysis in accordance with the Cochrane methodology. The analysis included a Group Reading Assessment and Diagnostic Evaluation assessments, Jadad Quality Score evaluations, and Risk of Bias in Randomized Studies of Interventions assessments. The PubMed, Ovid, EMBASE, Web of Science, MEDLINE, CNKI, VIP and WanFang databases were searched to collect and compare relevant randomized controlled trials and cohort studies of isobar nonfusion and PLIF in the treatment of lumbar degenerative diseases. The retrieval time was from database inception to June 2021. Two evaluators independently screened the literature, extracted data, and evaluated the quality of the included studies. Outcome measures of interest included low back pain, disability, and radiological features. The protocol for this systematic review was registered on INPLASY (2021110059) and is available in full on inplasy.com (https://inplasy.com/inplasy-2021-11-0059/).

Results

Of the 7 RCTs, 394 patients met the inclusion criteria. The meta-analysis results showed that isobar nonfusion surgery shortened the surgical duration (P = 0.03), reducing intraoperative bleeding (P = 0.001), retained the ROM of surgical segment (P < 0.00001) and the ROM of the lumbar spine (P < 0.00001), and reduced the incidence of ASD (P = 0.0001). However, no significant difference in the postoperative ODI index (P = 0.81), VAS score of LBP (P = 0.59, VAS score of lower limb pain (P = 0.05, and JOA score (P = 0.27) was noted.

Conclusions

Posterior lumbar nonfusion surgery with isobar devices is superior to PLIF in shortening the surgical duration, reducing intraoperative bleeding, retaining the ROM of surgical segments and the lumbar spine to a certain extent, and preventing ASD. Given the possible publication bias, we recommend further large-scale studies.

Huang RC, Girardi FP, Lim MR, et al. Advantages and disadvantages of nonfusion technology in spine surgery. Orthop Clin N Am. 2005;36(3):263–9. https://doi.org/10.1016/j.ocl.2005.02.006.CrossRef

Lee SE, Park SB, Jahng TA, et al. Clinical experience of the dynamic stabilization system for the degenerative spine disease. J Korean Neurosurg Soc. 2008. https://doi.org/10.3340/jkns.2008.43.5.221.CrossRefPubMedPubMedCentral

Chou D, Lau D, Skelly A, et al. Dynamic stabilization versus fusion for treatment of degenerative spine conditions. Evid Based Spine Care J. 2011;2(3):33–42. https://doi.org/10.1055/s-0030-1267111.CrossRefPubMedPubMedCentral

Shu-Fen S, Meng-Shan W, Wen-Ting Y, et al. Effects of lumbar fusion surgery with ISOBAR devices versus posterior lumbar interbody fusion surgery on pain and disability in patients with lumbar degenerative diseases: a meta-analysis. J Invest Surg. 2018. https://doi.org/10.1080/08941939.2018.1472318.CrossRef

Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e1000097. Open Med. 2009, 3(3):e123–30. https://doi.org/10.1016/j.jclinepi.2009.06.005

Cumpston M, Li T, Page MJ, et al. Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst Rev. 2019;10:ED000142. https://doi.org/10.1002/14651858.ED000142.CrossRefPubMed

Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA; Cochrane Bias Methods Group; Cochrane Statistical Methods Group. The Cochrane Collaboration's tool for assessing risk of bias in randomized trials. BMJ. 2011;343:d5928. https://doi.org/10.1136/bmj.d5928

Yang Y, Hong Y, Liu H, et al. Comparison of clinical and radiographic results between isobar posterior dynamic stabilization and posterior lumbar inter-body fusion for lumbar degenerative disease: a four-year retrospective study. Clin Neurol Neurosurg. 2015;136:100–6. https://doi.org/10.1016/j.clineuro.2015.06.003.CrossRefPubMed

Wen YF, Zhu LX, Min SX, et al. Comparative analysis of clinical efficacy of isobar TTL semi rigid dynamic internal fixation and rigid internal fixation in the treatment of lumbar degenerative diseases. Chin J Orthop Surg. 2011;19(05):373–7. https://doi.org/10.1111/j.1759-6831.2010.00112.x.CrossRef

10.

Li ZH, Wang SY, Fu Q, et al. Application of ISOBAR dynamic stabilization system in treatment of degenerative lumbar disease. Chin J Bone Joint Inj. 2011;26(11):973–6.

11.

Xu HD, Fu Q. Efficacy analysis of posterior isobar non fusion internal fixation system in the treatment of lumbar degenerative diseases. Chin J Orthop Surg. 2013;21(11):1149–52. https://doi.org/10.3977/j.issn.1005-8478.2013.11.19.CrossRef

12.

Liu YB, Fu Q. Repair of lumbar disc herniation with posterior isobar non fusion internal fixation system: it is more advantageous to restore lumbar mobility. China Tissue Eng Res. 2015;19(13):2051–6. https://doi.org/10.3969/j.issn.2095-4344.2015.13.016.CrossRef

13.

Feng XF, Zhang K, Tu Q, et al. Early efficacy of isobar TTL dynamic fixation in the treatment of multi-level lumbar degenerative diseases. Chin J Clin Basic Res Orthop. 2017. https://doi.org/10.3969/j.issn.1674-666X.2017.05.003.CrossRef

14.

Ji ZS, Yang H, Yang YH, et al. Analysis of clinical effect and radiographic outcomes of Isobar TTL system for two-segment lumbar degenerative disease: a retrospective study. BMC Surg. 2020. https://doi.org/10.1186/s12893-020-0680-8.CrossRefPubMedPubMedCentral

15.

Fritzell P, Hagg O, Nordwall A. Complications in lumbar fusion surgery for chronic low back pain: comparison of three surgical techniques used in a prospective randomized study. A report from the Swedish Lumbar Spine Study Group. Eur Spine J. 2003;12(2):178–89. https://doi.org/10.1007/s00586-002-0493-8.CrossRefPubMedPubMedCentral

16.

McNally DS, Shackleford IM, Goodship AE, et al. In vivo stress measurement can predict pain on discography. Spine (Phila Pa 1976). 1996;21(22):2580–7. https://doi.org/10.1097/00007632-199611150-00007.CrossRef

17.

Barrey CY. Dynamic instrumentation for fusion with isobar ttl™: Biomechanical and clinical aspects. ArgoSpine News J. 2010;22:62–6. https://doi.org/10.1007/s12240-010-0014-2.CrossRef

18.

Zhang XZ, Wang QF, Zhao ZY, et al. Efficacy and postoperative fusion rate of isobar TTL system in the treatment of lumbar degenerative diseases. China Bone Inj. 2019;32(10):914–8. https://doi.org/10.3969/j.issn.1003-0034.2019.10.008.CrossRef

19.

Bao ZH, Yang HL, Zhang ZM, et al. 3-year follow-up study of nucleus pulposus removal combined with dynamic fixation in the treatment of single segment lumbar disc herniation with segmental instability. Chin J Spine Spinal Cord. 2014;24(12):1085–9. https://doi.org/10.3969/j.issn.1004-406X.2014.12.06.CrossRef

20.

Wang H, Lv B. Comparison of clinical and radiographic results between posterior pedicle-based dynamic stabilization and posterior lumbar intervertebral fusion for lumbar degenerative disease: a 2-year retrospective study. World Neurosurg. 2018;114:e403–11. https://doi.org/10.1016/j.wneu.2018.02.192.CrossRefPubMed

21.

Korovessis P, Papazisis Z, Koureas G, et al. Rigid, semirigid versus dynamic instrumentation for degenerative lumbar spinal stenosis: a correlative radiological and clinical analysis of short-term results. Spine (Phila Pa 1976). 2004;29(7):735–42. https://doi.org/10.1097/01.BRS.0000112072.83196.0f.CrossRef

22.

Hrabalek L, Wanek T, Adamus M. Treatment of degenerative spondylolisthesis of the lumbosacral spine by decompression and dynamic transpedicular stabilisation. Acta Chir Orthop Traumatol Cech. 2011;78(5):431–6. https://doi.org/10.3928/01477447-20110826-09.CrossRefPubMed

23.

Moon KY, Lee SE, Kim KJ, et al. Back muscle changes after pedicle based dynamic stabilization. J Korean Neurosurg Soc. 2013;53(3):174–9. https://doi.org/10.3340/jkns.2013.53.3.174.CrossRefPubMedPubMedCentral

24.

Tian YX, Bao ZH, Zou J, et al. Short term effect of single segment isobar TTL system dynamic internal fixation in the treatment of lumbar degenerative diseases. China Tissue Eng Res. 2018;22(07):1020–5. https://doi.org/10.3969/j.issn.2095-4344.0052.CrossRef

25.

Rong X, Dou QY, Li XL, et al. Posterior dynamic stabilization with direct pars repair via wiltse approach for the treatment of lumbar spondylolysis: the application of a novel surgery. Spine (Phila Pa 1976). 2016;41(8):E494–502. https://doi.org/10.1097/BRS.0000000000001295.CrossRef

26.

Li Z, Li F, Yu S, et al. Two-year follow-up results of the isobar TTL semi-rigid rod system for the treatment of lumbar degenerative disease. J Clin Neurosci. 2013;20(3):394–9. https://doi.org/10.1016/j.jocn.2012.02.043.CrossRefPubMed

27.

Li Z, Shu X, Yang D, et al. Effectiveness of ISOBAR TTL semi-rigid dynamic stabilization system in treatment of lumbar degenerative disease. Zhong guo Xiu Fu Chong Jian Wai Ke Za Zhi. 2012;26(9):1066–70.

28.

Zhang ZM, Jin DD, Chen JT. Comparative study of dynamic fixation with rigid fixation in the management of degenerative lumbar spondylosis. Zhong hua Wai Ke Za Zhi. 2008;46(5):346–9. https://doi.org/10.3321/j.issn:0529-5815.2008.05.008.CrossRef

29.

Gao J, Zhao W, Zhang X, et al. MRI analysis of the ISOBAR TTL internal fixation system for the dynamic fixation of intervertebral discs: a comparison with rigid internal fixation. J Orthop Surg Res. 2014;9(1):43. https://doi.org/10.1186/1749-799X-9-43.CrossRefPubMedPubMedCentral

30.

Fu L, France A, Xie Y, et al. Functional and radiological outcomes of semi-rigid dynamic lumbar stabilization adjacent to single-level fusion after 2 years. Arch Orthop Trauma Surg. 2014;134(5):605–10. https://doi.org/10.1007/s00402-014-1961-4.CrossRefPubMed

31.

Yao XQ, Jiang H, Cheng YG, et al. Medium and long term follow-up results of isobar TTL system in the treatment of lumbar degenerative diseases. Chin J Orthop Surg. 2017;25(03):199–203. https://doi.org/10.3977/j.issn.1005-8478.2017.03.02.CrossRef

32.

Kumar MN, Baklanov A, Chopin D. Correlation between sagittal plane changes and adjacent segment degeneration following lumbar spine fusion. Eur Spine J. 2001;10(4):314–9. https://doi.org/10.1007/s005860000239.CrossRefPubMedPubMedCentral

33.

Chou WY, Hsu CJ, Chang WN, et al. Adjacent segment degeneration after lumbar spinal posterolateral fusion with instrumentation in elderly patients. Arch Orthop Trauma Surg. 2002;122(1):39–43. https://doi.org/10.1007/s004020100314.CrossRefPubMed

34.

Qian JL, Bao ZH, Li X, et al. Short-term therapeutic efficacy of the isobar TTL dynamic internal fixation system for the treatment of lumbar degenerative disc diseases. Pain Phys. 2016;19(6):E853–61.

35.

Chamoli U, Diwan AD, Tsafnat N. Pedicle screw-based posterior dynamic stabilizers for degenerative spine: in vitro biomechanical testing and clinical outcomes. J Biomed Mater Res A. 2014;102(9):3324–40. https://doi.org/10.1002/jbma.34986.CrossRefPubMed

36.

Liu JH, Jin AM, Duan Y, et al. Three-dimensional finite element analysis and comparison of isobar TTL semi rigid internal fixation system and USS rigid internal fixation system. J Second Milit Med Univ. 2013;34(04):416–20. https://doi.org/10.3724/SP.J.1008.2013.00416.CrossRef

37.

Lv JH, Tang ZH, Chen K, et al. Comparison of angular displacement and stress of lumbar intervertebral disc adjacent to semi-rigid and rigid internal fixation. China Tissue Eng Res. 2016;20(09):1275–81. https://doi.org/10.3969/j.issn.2095-4344.2016.09.009.CrossRef

38.

Tang HT, Zhao WD, Wu XJ. Effect of isobar TTL semi rigid dynamic fixation system on intervertebral load of lumbar fixed segments. Chin J Exp Surg. 2015;32(1):126–8. https://doi.org/10.3760/cma.j.issn.1001-9030.2015.01.044.CrossRef

Title: Effects of posterior lumbar nonfusion surgery with isobar devices versus posterior lumbar interbody fusion surgery on clinical and radiological features in patients with lumbar degenerative diseases: a meta-analysis
Authors: Jianbin Guan
Tao Liu
Wenhao Li
He Zhao
Kaitan Yang
Chuanhong Li
Ningning Feng
Guozheng Jiang
Yongdong Yang
Xing Yu
Publication date: 01-12-2022
Publisher: BioMed Central
Keyword: Degenerative Disease
Published in: Journal of Orthopaedic Surgery and Research / Issue 1/2022
Electronic ISSN: 1749-799X
DOI: https://doi.org/10.1186/s13018-022-03015-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Effects of posterior lumbar nonfusion surgery with isobar devices versus posterior lumbar interbody fusion surgery on clinical and radiological features in patients with lumbar degenerative diseases: a meta-analysis

Abstract

Purpose

Materials and method

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Materials and method

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2022

Conservative therapy versus arthroscopic surgery of femoroacetabular impingement syndrome (FAI): a systematic review and meta-analysis

Knockdown of lncRNA LINC00662 suppresses malignant behaviour of osteosarcoma cells via competition with miR-30b-3p to regulate ELK1 expression

Intrathecal morphine in combination with bupivacaine as pre-emptive analgesia in posterior lumbar fusion surgery: a retrospective cohort study

Low cervical vertebral CT value increased early subsidence of titanium mesh cage after anterior cervical corpectomy and fusion

Comparison of two coracoid process transfer techniques on stress shielding using three-dimensional finite-element model

Stress distributions of the short stem and the tapered wedge stem at different alignments: a finite element analysis study