Abstract
The aim of the current study was to evaluate changes in lumbar kinematics after lumbar monosegmental instrumented surgery with rigid fusion and dynamic non-fusion stabilization. A total of 77 lumbar spinal stenosis patients with L4 degenerative spondylolisthesis underwent L4–5 monosegmental posterior instrumented surgery. Of these, 36 patients were treated with rigid fusion (transforaminal lumbar interbody fusion) and 41 with dynamic stabilization [segmental spinal correction system (SSCS)]. Lumbar kinematics was evaluated with functional radiographs preoperatively and at final follow-up postoperatively. We defined the contribution of each segmental mobility to the total lumbar mobility as the percent segmental mobility [(sagittal angular motion of each segment in degrees)/(total sagittal angular motion in degrees) × 100]. Magnetic resonance imaging was performed on all patients preoperatively and at final follow-up postoperatively. The discs were classified into five grades based on the previously reported system. We defined the progress of disc degeneration as (grade at final follow-up) − (grade at preoperatively). No significant kinematical differences were shown at any of the lumbar segments preoperatively; however, significant differences were observed at the L2–3, L4–5, and L5–S1 segments postoperatively between the groups. At final follow-up, all of the lumbar segments with rigid fusion demonstrated significantly greater disc degeneration than those with dynamic stabilization. Our results suggest that the SSCS preserved 14% of the kinematical operations at the instrumented segment. The SSCS may prevent excessive effects on adjacent segmental kinematics and may prevent the incidence of adjacent segment disorder.
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Panjabi M, Henderson G, Abjornson C et al (2007) Multidirectional testing of one- and two-level ProDisc-L versus simulated fusions. Spine 32:1311–1319
Panjabi M, Malcolmson G, Teng E et al (2007) Hybrid testing of lumbar CHARITE discs versus fusions. Spine 32:959–966
Okuda S, Iwasaki M, Miyauchi A et al (2004) Risk factors for adjacent segment degeneration after PLIF. Spine 29:1535–1540
Throckmorton T, Hilibrand A, Mencio G et al (2003) The impact of the adjacent level disc degeneration on health status outcomes following lumbar fusion. Spine 28:2546–2550
Shono Y, Kaneda K, Abumi K et al (1998) Stability of posterior spinal instrumentation and its effects on adjacent motion segments in the lumbosacral spine. Spine 23:1550–1558
Chow DH, Luk KD, Evans JH et al (1996) Effects of short anterior lumbar interbody fusion on biomechanics of neighboring unfused segments. Spine 21:549–555
Esses SI, Doherty BJ, Crawford MJ et al (1996) Kinematics evaluation of lumbar fusion techniques. Spine 21:676–684
Ghiselli G, Wang JC, Bhatia NN et al (2004) Adjacent segment degeneration in the lumbar spine. J Bone Joint Surg Am 86:1497–1503
McAffee PC, Farey ID, Suttelin CE et al (1989) 1989 Volvo award in basic science. Device-related osteoporosis with spinal instrumentation. Spine 14:919–926
Cakir B, Carazzo C, Schmidt R et al (2009) Adjacent segment mobility after rigid and semirigid instrumentation of the lumbar spine. Spine 34:1287–1291
Korovessis P, Papazisis Z, Koureas G et al (2004) Rigid, semirigid versus dynamic instrumentation for degenerative lumbar spinal stenosis. A correlative radiological and clinical analysis of short-term results. Spine 29:735–742
Strempel AV, Neekritz A, Muelenaere PD et al (2000) Dynamic versus rigid spinal implants. In: Gunzburg R, Szpalski M (eds) Lumbar Spinal Stenosis, vol 31. Lippincott Williams & Wilkins, Philadelphia, pp 275–285
Strempel AV, Stoss C, Moosmann D et al (2006) Non-fusion stabilization of the lumbar spine in the case of degenerative diseases with a dynamic pedicle screw rod. Coluna/Columna 5:27–34
Wilke HJ, Heuer F, Schmidt H (2009) Prospective design delineation and subsequent in vitro evaluation of a new posterior dynamic stabilization system. Spine 34:255–261
Kumar A, Beastall J, Hughes J et al (2008) Disc changes in the bridged and adjacent segments after dynesys dynamic stabilization system after two years. Spine 33:2909–2914
Niosi CA, Wilson DC, Zhu Q et al (2008) The effect of dynamic posterior stabilization on facet joint contact forces. An in vitro investigation. Spine 33:19–26
Cheng BC, Gordon J, Cheng J et al (2007) Immediate biomechanical effects of lumbar posterior dynamic stabilization above a circumferential fusion. Spine 32:2551–2557
Kanayama M, Hashimoto T, Shigenobu K et al (2007) A minimum 10-year follow-up of posterior dynamic stabilization using Graf artificial ligament. Spine 32:1992–1996
Beastall J, Karadimas E, Siddiqui M et al (2007) The Dynesys lumbar spinal stabilization system. A preliminary report on positional magnetic resonance imaging findings. Spine 32:685–690
Schnake KJ, Schaeren S, Jeanneret B et al (2006) Dynamic stabilization in addition to decompression for lumbar spinal stenosis with degenerative spondylolithesis. Spine 31:442–449
Grob D, Benini A, Junge A et al (2005) Clinical experience with the Dynesys semirigid fixation system for the lumbar spine. Spine 30:324–331
Meyerding HW (1931) Spondylolisthesis. J Bone Joint Surg Am 13:39–48
Izumida S, Inoue S (1986) Japanese Orthopedic Association Assessment of surgical treatment of low back pain (in Japanese). J Jpn Orthop Assoc 60:391–394
Hirabayashi K, Miyakawa J, Satomi K et al (1981) Operative results and postoperative progression of ossification among patients with ossification of cervical posterior longitudinal ligament. Spine 6:354–365
Pfirrmann CW, Metzdorf A, Zanetti M et al (2001) Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine 26:1873–1878
Hadlow SV, Fagan AB, Hillier TM et al (1998) The Graf ligamentoplasty procedure: comparison with posterolateral fusion in the management of low back pain. Spine 23:1172–1179
Rigby MC, Selmon GP, Foy MA et al (2001) Graf ligament stabilization: mid- to long-term follw-up. Eur Spine J 10:234–236
Schaeren S, Broger I, Jeanneret B (2008) Minimum four-year follow-up of spinal stenosis with degenerative spondylolisthesis treated with decompression and dynamic stabilization. Spine 33:E636–E642
Schmoelz W, Huber JF, Nydegger T et al (2003) Dynamic stabilization of the lumbar spine and its effects on adjacent segments: an in vitro experiment. J Spinal Disord Tech 16:418–423
Cunningham BW, Kotani Y, McNulty PS et al (1997) The effect of spinal destabilization and instrumentation on lumbar intradiscal pressure. An in vitro biomechanical analysis. Spine 22:2655–2663
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Morishita, Y., Ohta, H., Naito, M. et al. Kinematic evaluation of the adjacent segments after lumbar instrumented surgery: a comparison between rigid fusion and dynamic non-fusion stabilization. Eur Spine J 20, 1480–1485 (2011). https://doi.org/10.1007/s00586-011-1701-1
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DOI: https://doi.org/10.1007/s00586-011-1701-1