The Incidence of Adjacent Segment Degeneration after the Use of a Versatile Dynamic Hybrid Stabilization Device in Lumbar Stenosis: Results of a 5–8-Year Follow-up

Dobran, Mauro; Nasi, Davide; Esposito, Domenico Paolo; Gladi, Maurizio; Scerrati, Massimo; Iacoangeli, Maurizio

Abstract

STUDY DESIGN: Retrospective study with long-term follow-up. PURPOSE: To evaluate the long-term incidence of adjacent segment degeneration (ASD) and clinical outcomes in a consecutive series of patients who underwent spinal decompression associated with dynamic or hybrid stabilization with a Flex+TM stabilization system (SpineVision, Antony, France) for lumbar spinal stenosis. OVERVIEW OF LITERATURE: The incidence of ASD and clinical outcomes following dynamic or hybrid stabilization with the Flex+TM system used for lumbar spinal stenosis have not been well investigated.
METHODS
Twenty-one patients with lumbar stenosis and probable post-decompressive spinal instability underwent decompressive laminectomy followed by spinal stabilization using the Flex+TM stabilization system. The indication for a mono-level dynamic stabilization was a preoperative magnetic resonance imaging (MRI) demonstrating evidence of severe disc disease associated with severe spinal stenosis. The hybrid stabilization (rigid-dynamic) system was used for multilevel laminectomies with associated initial degenerative scoliosis, first-grade spondylolisthesis, or rostral pathology.
RESULTS
The improvement in Visual Analog Scale and Oswestry Disability Index scores at follow-up were statistically significant (p < 0.0001 and p < 0.0001, respectively). At the 5-8-year follow-up, clinical examination, MRI, and X-ray findings showed an ASD complication with pain and disability in one of 21 patients. The clinical outcomes were similar in patients treated with dynamic or hybrid fixation.
CONCLUSIONS
Patients treated with laminectomy and Flex+TM stabilization presented a satisfactory clinical outcome after 5-8 years of follow-up, and ASD incidence in our series was 4.76% (one patient out of 21). We are aware that this is a small series, but our long-term follow-up may be sufficient to contribute to the expanding body of literature on the development of symptomatic ASD associated with dynamic or hybrid fixation.