Clin Orthop Surg.  2017 Sep;9(3):310-316. 10.4055/cios.2017.9.3.310.

Lumbar Single-Level Dynamic Stabilization with Semi-Rigid and Full Dynamic Systems: A Retrospective Clinical and Radiological Analysis of 71 Patients

• Ozer AF
• Oktenoglu
• Egemen E
• Sasani M
• Yilmaz A
• Erbulut DU
• Yaman O
• Suzer T

• KMID: 2412267
• DOI: http://doi.org/10.4055/cios.2017.9.3.310

Abstract

BACKGROUND
This study compares the clinical and radiological results of three most commonly used dynamic stabilization systems in the field of orthopedic surgery.
METHODS
A total of 71 patients underwent single-level posterior transpedicular dynamic stabilization between 2011 and 2014 due to lumbar degenerative disc disease. Three different dynamic systems used include: (1) the Dynesys system; (2) a dynamic screw with a PEEK rod; and (3) a full dynamic system (a dynamic screw with a dynamic rod; BalanC). The mean patient age was 45.8 years. The mean follow-up was 29.7 months. Clinical and radiological data were obtained for each patient preoperatively and at 6, 12, and 24 months of follow-up.
RESULTS
Clinical outcomes were significantly improved in all patients. There were no significant differences in the radiological outcomes among the groups divided according to the system used. Screw loosening was detected in 2 patients, and 1 patient developed screw breakage. All patients with screw loosening or breakage underwent revision surgery.
CONCLUSIONS
Each procedure offered satisfactory outcome regardless of which system was applied.

Keyword

Disc degeneration; Instrumentation; Pedicle screw

MeSH Terms

Female
Humans
Intervertebral Disc Degeneration/complications/diagnostic imaging/*surgery
Low Back Pain/diagnostic imaging/etiology/*surgery
Lumbar Vertebrae/diagnostic imaging/*surgery
Male
Middle Aged
Pedicle Screws
Radiography
Retrospective Studies

Figure

• 

  Fig. 1 The intervertebral space ratio was measured by dividing half of the sum of the anterior (A) and posterior (B) intervertebral disc heights by the upper vertebral body height (H). The lumbar lordosis (LL) angle was measured as the angle between the superior endplates of L1 and S1. The segmental lordosis (α) angle was measured as the angle created by a line drawn from the superior endplate of the upper vertebra and a line drawn from the inferior endplate of the lower vertebra of the operation segment.

• 

  Fig. 2 A 61-year-old female patient complained of back pain and left sciatica. She had an approximate 20-year history of back pain attacks. During the latest attack, she noticed sciatica in her left leg. (A) The T2-weighted sagittal magnetic resonance imaging (MRI) showed spontaneous L5–S1 level fusion (yellow arrow) and herniation at level L4–5 (white arrow). (B) The axial section of T2-weighted MRI showed protrusion of the disc on the left side (white arrow). The lateral direct X-ray (C) and anteroposterior X-ray (D) were taken 2 years after the operation performed using dynamic screws (blue arrows) and a dynamic rod (red arrows) (BalanC; Medtronic Sofamor Danek). Postoperatively, the patient had no complaint of back pain or severe back pain attacks.

• 

  Fig. 3 A 55-year-old male patient had severe back pain and left leg pain. The patient had severe back pain attacks intermittently for 30 years. (A) The T2-weighted sagittal magnetic resonance imaging (MRI) showed lumbar disc herniation at the L4–5 level (arrow). (B) The axial section of T2-weighted MRI showed disc herniation on the left side (arrow). The lateral direct (C) and anteroposterior X-ray (D) show the Dynesys system (Zimmer Spine) used for stabilization in the patient.

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  Fig. 4 A 47-year-old female patient had severe back pain attacks for a total of 8 years with 4 severe attacks occurring in the most recent year. Each pain episode lasted 1 week. (A) The T2-weighted sagittal magnetic resonance imaging (MRI) showed herniation at the L4–5 level (white arrow). (B) The axial section of T2-weighted MRI showed midline protrusion at the L4–5 level (white arrow). The lateral direct X-ray (C) and anteroposterior X-ray (D) were taken following stabilization with a dynamic screw and a dynamic PEEK rod (blue arrows) in the patient.

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