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Multi-segmental lumbar spinal stenosis treated with Dynesys stabilization versus lumbar fusion in elderly patients: a retrospective study with a minimum of 5 years’ follow-up

Archives of Orthopaedic and Trauma Surgery volume 139, pages 1361–1368 (2019)Cite this article

Abstract

Introduction

Middle- and long-term outcomes of multi-segmental lumbar spinal stenosis treated with Dynesys stabilization (DS) have rarely been reported. Older age and multi-segmental degeneration may be positive factors in achieving satisfactory outcomes following DS. The present study aimed to compare the middle- and long-term outcomes of DS with lumbar fusion for treatment of multi-segmental lumbar spinal stenosis (ms-LSS) in elderly patients.

Materials and methods

This study retrospectively analyzed patients with ms-LSS treated by DS or lumbar fusion from January 2011 to April 2013. Twenty-two patients were included in the Dynesys group, and 44 patients treated by lumbar fusion and rigid fixation were included in the fusion group. Clinical outcomes were assessed by VAS and ODI. Radiological outcomes were measured by range of motion (ROM) of stabilized segments and the proximal adjacent segment, intervertebral disc height (DH) and L1–S1 lumbar lordosis angle (LL). Modified Pfirrmann grade score was used to access disc degeneration.

Outcomes

The mean follow-up time of the Dynesys group and fusion group was 68.50 ± 6.40 and 70.14 ± 7.26 months, respectively. Baseline data were similar between the two groups. There were no significant differences between the two groups in terms of improvement of clinical outcomes (VAS and ODI). DS preserved a certain degree of ROM (3.74 ± 2.00) of surgical segments. ROM of proximal adjacent segment underwent an increase in both groups at the final follow-up. The DH of the surgical segments and proximal adjacent segment in both groups was significantly lower than that before surgery (P = 0.000). LL of both groups improved (P = 0.000), and there was no significant difference between the two groups. The modified Pfirrmann score of proximal adjacent segment of both groups increased at the final follow-up. The fusion group underwent a more significant increase (P = 0.000), whereas the inter-group difference showed no significance (P = 0.090).

Conclusion

DS is a safe and effective surgical treatment of multi-segmental lumbar spinal stenosis in the elderly population. DS preserves a certain degree of mobility of surgical segments.

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References

  1. Fehlings MG, Tetreault L, Nater A, Choma T, Harrop J, Mroz T, Santaguida C, Smith JS (2015) The aging of the global population: the changing epidemiology of disease and spinal disorders. Neurosurgery 77(Suppl 4):S1–S5. https://doi.org/10.1227/NEU.0000000000000953

    Article  PubMed  Google Scholar 

  2. Pearson A, Lurie J, Tosteson T, Zhao W, Abdu W, Weinstein JN (2012) Who should have surgery for spinal stenosis? Treatment effect predictors in SPORT. Spine (Phila Pa 1976) 37:1791–1802. https://doi.org/10.1097/BRS.0b013e3182634b04

    Article  Google Scholar 

  3. Deyo RA (2010) Treatment of lumbar spinal stenosis: a balancing act. Spine J 10:625–627. https://doi.org/10.1016/j.spinee.2010.05.006

    Article  PubMed  Google Scholar 

  4. Lonne G, Fritzell P, Hagg O, Nordvall D, Gerdhem P, Lagerback T, Andersen M, Eiskjaer S, Gehrchen M, Jacobs W, Hooff ML, Solberg TK (2019) Lumbar spinal stenosis: comparison of surgical practice variation and clinical outcome in three national spine registries. Spine J 19:41–49. https://doi.org/10.1016/j.spinee.2018.05.028

    Article  PubMed  Google Scholar 

  5. Kim CH, Chung CK, Kim MJ, Choi Y, Kim MJ, Shin S, Jung JM, Hwang SH, Yang SH, Park SB, Lee JH (2018) Increased volume of surgery for lumbar spinal stenosis and changes in surgical methods and outcomes: a nationwide cohort study with a 5-year follow-up. World Neurosurg 119:e313–e322. https://doi.org/10.1016/j.wneu.2018.07.139

    Article  PubMed  Google Scholar 

  6. Lonne G, Schoenfeld AJ, Cha TD, Nygaard OP, Zwart J, Solberg T (2017) Variation in selection criteria and approaches to surgery for lumbar spinal stenosis among patients treated in Boston and Norway. Clin Neurol Neurosurg 156:77–82. https://doi.org/10.1016/j.clineuro.2017.03.008

    Article  PubMed  Google Scholar 

  7. Deyo RA, Mirza SK, Martin BI, Kreuter W, Goodman DC, Jarvik JG (2010) Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults. JAMA 303:1259–1265. https://doi.org/10.1001/jama.2010.338

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  8. Jancuska JM, Hutzler L, Protopsaltis TS, Bendo JA, Bosco J (2016) Utilization of lumbar spinal fusion in New York State: trends and disparities. Spine (Phila Pa 1976) 41:1508–1514. https://doi.org/10.1097/BRS.0000000000001567

    Article  Google Scholar 

  9. Son S, Kim WK, Lee SG, Park CW, Lee K (2013) A comparison of the clinical outcomes of decompression alone and fusion in elderly patients with two-level or more lumbar spinal stenosis. J Korean Neurosurg Soc 53:19–25. https://doi.org/10.3340/jkns.2013.53.1.19

    Article  PubMed  PubMed Central  Google Scholar 

  10. Zhang C, Berven SH, Fortin M, Weber MH (2016) Adjacent segment degeneration versus disease after lumbar spine fusion for degenerative pathology: a systematic review with meta-analysis of the literature. Clin Spine Surg 29:21–29. https://doi.org/10.1097/BSD.0000000000000328

    Article  PubMed  Google Scholar 

  11. Lee CS, Chung SS, Shin SK, Park SJ, Lee HI, Kang KC (2011) Differences in post-operative functional disability and patient satisfaction between patients with long (three levels or more) and short (less than three) lumbar fusions. J Bone Jt Surg Br 93:1400–1404. https://doi.org/10.1302/0301-620X.93B10.27099

    CAS  Article  Google Scholar 

  12. Schulte TL, Hurschler C, Haversath M, Liljenqvist U, Bullmann V, Filler TJ, Osada N, Fallenberg EM, Hackenberg L (2008) The effect of dynamic, semi-rigid implants on the range of motion of lumbar motion segments after decompression. Eur Spine J 17:1057–1065. https://doi.org/10.1007/s00586-008-0667-0

    Article  PubMed  PubMed Central  Google Scholar 

  13. Wang Q, Liu J, Shi Y, Chen Y, Yu H, Ma J, Ren W, Yang H, Wang H, Xiang L (2016) Short-term effects of a dynamic neutralization system (Dynesys) for multi-segmental lumbar disc herniation. Eur Spine J 25:1409–1416. https://doi.org/10.1007/s00586-015-4307-1

    Article  PubMed  Google Scholar 

  14. Yu SW, Yen CY, Wu CH, Kao FC, Kao YH, Tu YK (2012) Radiographic and clinical results of posterior dynamic stabilization for the treatment of multisegment degenerative disc disease with a minimum follow-up of 3 years. Arch Orthop Trauma Surg 132:583–589. https://doi.org/10.1007/s00402-012-1460-4

    Article  PubMed  Google Scholar 

  15. Fei H, Xu J, Wang S, Xie Y, Ji F, Xu Y (2015) Comparison between posterior dynamic stabilization and posterior lumbar interbody fusion in the treatment of degenerative disc disease: a prospective cohort study. J Orthop Surg Res 10:87. https://doi.org/10.1186/s13018-015-0231-7

    Article  PubMed  PubMed Central  Google Scholar 

  16. Haddad B, Makki D, Konan S, Park D, Khan W, Okafor B (2013) Dynesys dynamic stabilization: less good outcome than lumbar fusion at 4-year follow-up. Acta Orthop Belg 79:97–103

    PubMed  Google Scholar 

  17. St-Pierre GH, Jack A, Siddiqui MM, Henderson RL, Nataraj A (2016) Nonfusion does not prevent adjacent segment disease: Dynesys long-term outcomes with minimum five-year follow-up. Spine (Phila Pa 1976) 41:265–273. https://doi.org/10.1097/BRS.0000000000001158

    Article  Google Scholar 

  18. Griffith JF, Wang YX, Antonio GE, Choi KC, Yu A, Ahuja AT, Leung PC (2007) Modified Pfirrmann grading system for lumbar intervertebral disc degeneration. Spine (Phila Pa 1976) 32:E708–E712. https://doi.org/10.1097/BRS.0b013e31815a59a0

    Article  Google Scholar 

  19. Kepler CK, Vaccaro AR, Hilibrand AS, Anderson DG, Rihn JA, Albert TJ, Radcliff KE (2014) National trends in the use of fusion techniques to treat degenerative spondylolisthesis. Spine (Phila Pa 1976) 39:1584–1589. https://doi.org/10.1097/BRS.0000000000000486

    Article  Google Scholar 

  20. Lee CH, Jahng TA, Hyun SJ, Kim CH, Park SB, Kim KJ, Chung CK, Kim HJ, Lee SE (2016) Dynamic stabilization using the Dynesys system versus posterior lumbar interbody fusion for the treatment of degenerative lumbar spinal disease: a clinical and radiological outcomes-based meta-analysis. Neurosurg Focus 40:E7. https://doi.org/10.3171/2015.10.FOCUS15426

    Article  PubMed  Google Scholar 

  21. Liu K, Sun W, Lu Q, Chen J, Tang J (2017) A cost-utility analysis of Dynesys dynamic stabilization versus instrumented fusion for the treatment of degenerative lumbar spine diseases. J Orthop Sci 22:982–987. https://doi.org/10.1016/j.jos.2017.07.007

    Article  PubMed  Google Scholar 

  22. Prud'Homme M, Barrios C, Rouch P, Charles YP, Steib JP, Skalli W (2015) Clinical outcomes and complications after pedicle-anchored dynamic or hybrid lumbar spine stabilization: a systematic literature review. J Spinal Disord Tech 28:E439–E448. https://doi.org/10.1097/BSD.0000000000000092

    Article  PubMed  Google Scholar 

  23. Di Silvestre M, Lolli F, Bakaloudis G (2014) Degenerative lumbar scoliosis in elderly patients: dynamic stabilization without fusion versus posterior instrumented fusion. Spine J 14:1–10. https://doi.org/10.1016/j.spinee.2012.10.023

    Article  PubMed  Google Scholar 

  24. Zhang Y, Shan JL, Liu XM, Li F, Guan K, Sun TS (2016) Comparison of the Dynesys dynamic stabilization system and posterior lumbar interbody fusion for lumbar degenerative disease. PLoS ONE 11:e148071. https://doi.org/10.1371/journal.pone.0148071

    CAS  Article  Google Scholar 

  25. Pham MH, Mehta VA, Patel NN, Jakoi AM, Hsieh PC, Liu JC, Wang JC, Acosta FL (2016) Complications associated with the Dynesys dynamic stabilization system: a comprehensive review of the literature. Neurosurg Focus 40:E2. https://doi.org/10.3171/2015.10.FOCUS15432

    Article  PubMed  Google Scholar 

  26. Cakir B, Carazzo C, Schmidt R, Mattes T, Reichel H, Kafer W (2009) Adjacent segment mobility after rigid and semirigid instrumentation of the lumbar spine. (Phila Pa 1976) 34:1287–1291. https://doi.org/10.1097/BRS.0b013e3181a136ab

    Article  Google Scholar 

  27. Kim CH, Chung CK, Jahng TA (2011) Comparisons of outcomes after single or multilevel dynamic stabilization: effects on adjacent segment. J Spinal Disord Tech 24:60–67. https://doi.org/10.1097/BSD.0b013e3181d4eb44

    Article  PubMed  Google Scholar 

  28. Wu JC, Huang WC, Tsai HW, Ko CC, Wu CL, Tu TH, Cheng H (2011) Pedicle screw loosening in dynamic stabilization: incidence, risk, and outcome in 126 patients. Neurosurg Focus 31:E9. https://doi.org/10.3171/2011.7.FOCUS11125

    Article  PubMed  Google Scholar 

  29. Wurgler-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 (Phila Pa 1976) 33:E66–E72. https://doi.org/10.1097/BRS.0b013e31816245c0

    Article  Google Scholar 

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Funding

This study was funded by Science and Technology Commission of Shanghai Municipality (Grant number 15411951400).

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Author notes

  1. Annan Hu and Chi Sun have contributed equally to this study.

Affiliations

  1. Department of Orthopeadic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, People’s Republic of China

    Annan Hu, Chi Sun, Yun Liang, Houlei Wang, Xilei Li & Jian Dong

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  1. Annan Hu
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  2. Chi Sun
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  3. Yun Liang
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Correspondence to Xilei Li or Jian Dong.

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Hu, A., Sun, C., Liang, Y. et al. Multi-segmental lumbar spinal stenosis treated with Dynesys stabilization versus lumbar fusion in elderly patients: a retrospective study with a minimum of 5 years’ follow-up. Arch Orthop Trauma Surg 139, 1361–1368 (2019). https://doi.org/10.1007/s00402-019-03234-3

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  • DOI: https://doi.org/10.1007/s00402-019-03234-3

Keywords

  • Lumbar spinal stenosis (LSS)
  • Multi-segmental
  • Dynesys
  • Fusion
  • Elderly