Advertisement

European Spine Journal

, Volume 19, Issue 12, pp 2164–2170 | Cite as

Posterior dynamic stabilization of the lumbar spine with the Accuflex rod system as a stand-alone device: experience in 20 patients with 2-year follow-up

  • Alejandro Reyes-Sánchez
  • Barón Zárate-KalfópulosEmail author
  • Isabel Ramírez-Mora
  • Luis Miguel Rosales-Olivarez
  • Armando Alpizar-Aguirre
  • Guadalupe Sánchez-Bringas
Original Article

Abstract

Decompression surgery for lumbar spinal stenosis is a common procedure. After surgery, segmental instability sometimes occurs, therefore, different methods for restabilization have been developed. Dynamic stabilization systems have been designed to improve segmental stability. In this study, clinical results of patients with lumbar spinal stenosis that underwent decompression and stabilization with the Accuflex dynamic system are presented; clinical, radiographic, and magnetic resonance imaging (MRI) findings are fully described. Improvements in all clinical measurements, including visual analog scale for back and leg pain, Oswestry disability index, and SF-36 health status survey were noticed. At a 2-year follow-up, 22.22% of patients required hardware removal due to fatigue while in 83% of them no progression of disk degeneration was observed after implantation of the Accuflex system. Additionally, as demonstrated by the MRI images at follow up, three patients (16%) showed disk rehydration with one grade higher on the Pfirmann classification. Although a relatively high hardware failure was observed (22.22%), the use of the dynamic stabilization system Accuflex posterior to decompression procedures, showed clinical benefits and stopped the degenerative process in 83% the patients.

Keywords

Dynamic spine stabilization Spinal stenosis Disk herniation Disk regeneration Dynamic rods 

References

  1. 1.
    Bordes-Monmeneu M, Bordes-Garcia V, Rodrigo-Baeza F, Saéz D (2005) System of dynamic neutralization in the lumbar spine: experience on 94 cases. Neurocirugia (Astur) 16:499–506Google Scholar
  2. 2.
    Carreon LY, Puno RM, Dimar JR 2nd, Glassman SD, Johnson JR (2003) Perioperative complications of posterior lumbar decompression and arthrodesis in older adults. J Bone Joint Surg Am 85:2089–2092PubMedGoogle Scholar
  3. 3.
    Fujiwara A, Tamai K, An HS, Kurihashi T, Lim TH, Yoshida H, Saotome K (2000) The relationship between disc degeneration, facet joint osteoarthritis, and stability of the degenerative lumbar spine. J Spinal Disord 13(5):444–500CrossRefPubMedGoogle Scholar
  4. 4.
    Gillet P (2003) The fate of the adjacent motion segments after lumbar fusion. J Spinal Disord Tech 16:338–345PubMedGoogle Scholar
  5. 5.
    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 30:324–331CrossRefPubMedGoogle Scholar
  6. 6.
    Gunzburg R, Szpalski M (2003) The conservative surgical treatment of lumbar spinal stenosis in the elderly. Eur Spine J 12(Suppl 2):S176–S180CrossRefPubMedGoogle Scholar
  7. 7.
    Kalanithi PS, Patil CG, Boakye M (2009) National complication rates and disposition after posterior lumbar fusion for acquired spondylolisthesis. Spine 34:1963–1969CrossRefPubMedGoogle Scholar
  8. 8.
    Klaus JS, Putzier M, Haas N, Kandziora F (2006) Mechanical concepts for disc regeneration. Eur Spine J 15:S354–S360CrossRefGoogle Scholar
  9. 9.
    Kroeber M, Unglaub F, Guehring T, Nerlich A, Hadi T, Lotz J, Carstens C (2005) Effects of controlled dynamic disc distraction on degenerated intervertebral discs. An in vivo study on the rabbit lumbar spine model. Spine 30:181–187CrossRefPubMedGoogle Scholar
  10. 10.
    Kumar MN, Jacquot F, Hall H (2001) Long-term follow-up of functional outcomes and radiographic changes at adjacent levels following lumbar spine fusion for degenerative disc disease. Eur Spine J 10:309–313CrossRefPubMedGoogle Scholar
  11. 11.
    Lee CK (1988) Accelerated degeneration of the segment adjacent to a lumbar fusion. Spine 13:375–377CrossRefPubMedGoogle Scholar
  12. 12.
    Mandigo C, Sampath P, Kaiser M (2007) Posterior dynamic stabilization of the lumbar spine: pedicle based stabilization with the AccuFlex rod system. Neurosurg Focus 22:E9 1–4Google Scholar
  13. 13.
    Meyers K, Tauber M, Sudin Y, Fleischer S, Arnin U, Firardi F, Wright T (2008) Use of instruments pedicle screws to evaluate load sharing in posterior dynamic stabilization systems. Spine J 8:926–932CrossRefPubMedGoogle Scholar
  14. 14.
    Modic MT, Ross JS (2007) Lumbar degenerative disk disease. Radiology 245:43–61CrossRefPubMedGoogle Scholar
  15. 15.
    Mimura M, Panjabi MM, Oxland TR, Crisco JJ, Yamamoto I, Vasavada A (1994) Disc degeneration affects the multidirectional flexibility of the lumbar spine. Spine 19:1371–1380CrossRefPubMedGoogle Scholar
  16. 16.
    Nockels RP (2005) Dynamic stabilization in the surgical management of painful lumbar spinal disorders. Spine 30:S68–S72CrossRefPubMedGoogle Scholar
  17. 17.
    Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N (2001) Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine 26:1873–1878CrossRefPubMedGoogle Scholar
  18. 18.
    Putzier M, Schneider S, Funk J, Tohtz S, Perka C (2005) The surgical treatment of the lumbar disc prolapse nucleotomy with additional transpedicular dynamic stabilization versus nucleotomy alone. Spine 30:E109–E114CrossRefPubMedGoogle Scholar
  19. 19.
    Schnake KJ, Schaeren S, Jeanneret B (2006) Dynamic stabilization in addition to decompression for lumbar stenosis with degenerative spondylolisthesis. Spine 31:442–449CrossRefPubMedGoogle Scholar
  20. 20.
    Schulte TL, Hurschler C, Haversath M, Liljenqvist U, Bullman V, Filler T, Osada N, Fallenberg E, Hackenber L (2008) The effect of dynamic, semi-rigid implants on the range of motion of lumbar motion segments after decompression. Eur Spine J 17:1057–1065CrossRefPubMedGoogle Scholar
  21. 21.
    Sengupta DK, Mullholland RC (2005) Fulcrum assisted soft stabilization system: a new concept of the surgical treatment of degenerative low back pain. Spine 30:1019–1029CrossRefPubMedGoogle Scholar
  22. 22.
    Siepe CJ, Mayer HM, Wiechert K, Korge A (2006) Clinical results of total lumbar disc replacement with prodisc II: three-year results for different indications. Spine 31:1923–1932CrossRefPubMedGoogle Scholar
  23. 23.
    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–S178PubMedGoogle Scholar
  24. 24.
    Turner JA, Ersek M, Herron L, Haselkorn J, Kent D, Ciol MA, Deyo R (1991) Patients outcomes after lumbar spinal fusions. JAMA 268:907–911CrossRefGoogle Scholar
  25. 25.
    Welch WC, Cheng BC, Awad TE, Davis R, Maxwell JH, Delamarter R, Wingate J, Sherman J, Macenski M (2007) Clinical outcomes of the Dynesys dynamic neutralization system: 1-year preliminary results. Neurosurg Focus 22:E8CrossRefPubMedGoogle Scholar
  26. 26.
    Wilke H, Drumm J, Häussler K, Mack C, Steudel I, Kettler A (2008) Biomechanical effect of different lumbar interspinous implants on flexibility and intradiscal pressure. Eur Spine J 17:1049–1056CrossRefPubMedGoogle Scholar
  27. 27.
    Würgler-Hauri CC, Kalbarczyk A, Wiesli M, Landolt H, Fandino J (2008) Dynamic neutralization of the lumbar spine after microsurgical decompression in acquired lumbar spinal stenosis and segmental instability. Spine 33(3):E66–E72CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Alejandro Reyes-Sánchez
    • 1
  • Barón Zárate-Kalfópulos
    • 2
    Email author
  • Isabel Ramírez-Mora
    • 3
  • Luis Miguel Rosales-Olivarez
    • 2
  • Armando Alpizar-Aguirre
    • 2
  • Guadalupe Sánchez-Bringas
    • 2
  1. 1.Division of Special SurgeryInstituto Nacional de RehabilitaciónMexico Distrito FederalMexico
  2. 2.Department of Spinal SurgeryInstituto Nacional de RehabilitaciónMexico Distrito FederalMexico
  3. 3.Magnetic Resonance DepartmentInstituto Nacional de RehabilitaciónMexico Distrito FederalMexico

Personalised recommendations