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Molecular MR imaging for the evaluation of the effect of dynamic stabilization on lumbar intervertebral discs

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Abstract

The dynamic stabilization of lumbar spine is a non-fusion stabilization system that unloads the disc without the complete loss of motion at the treated motion segment. Clinical outcomes are promising but still not definitive, and the long-term effect on instrumented and adjacent levels is still a matter of discussion. Several experiments have been devised in order to gain a better understanding of the effect of the device on the intervertebral disc. One of the hypotheses was that while instrumented levels are partially relieved from loading, adjacent levels suffer from the increased stress. But this has not been proved yet. The aim of this study was to investigate the long-term effect of dynamic stabilization in vivo, through the quantification of glycosaminoglycans (GAG) concentration within instrumented and adjacent levels by means of the delayed Gadolinium-Enhanced Magnetic Resonance Imaging of Cartilage (dGEMRIC) protocol. Ten patients with low back pain, unresponsive to conservative treatment and scheduled for Dynesys implantation at one to three lumbar spine levels, underwent the dGEMRIC protocol to quantify GAG concentration before and 6 months after surgery. Each patient was also evaluated with visual analog scale (VAS), Oswestry, Prolo, Modic and Pfirrmann scales, both at pre-surgery and at follow-up. Six months after implantation, VAS, Prolo and Oswestry scales had improved in all patients. Pfirrmann scale could not detect any change, while dGEMRIC data already showed a general improvement in the instrumented levels: GAG was increased in 61% of the instrumented levels, while 68% of the non-instrumented levels showed a decrease in GAG, mainly in the posterior disc portion. In particular, seriously GAG-depleted discs seemed to have the greatest benefit from the Dynesys implantation, whereas less degenerated discs underwent a GAG depletion. dGEMRIC was able to visualize changes in both instrumented and non-instrumented levels. Our results suggest that the dynamic stabilization of lumbar spine is able to stop and partially reverse the disc degeneration, especially in seriously degenerated discs, while incrementing the stress on the adjacent levels, where it induces a matrix suffering and an early degeneration.

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References

  1. Mulholland RC, Sengupta DK (2002) Rationale, principles and experimental evaluation of the concept of soft stabilization. Eur Spine J 11(Suppl 2):S198–S205

    PubMed  Google Scholar 

  2. Harrop JS, Youssef JA, Maltenfort M, Vorwald P, Jabbour P, Bono CM et al (2008) Lumbar adjacent segment degeneration and disease after arthrodesis and total disc arthroplasty. Spine 33(15):1701–1707

    Article  PubMed  Google Scholar 

  3. Min JH, Jang JS, Jung BJ, Lee HY, Choi WC, Shim CS et al (2008) The clinical characteristics and risk factors for the adjacent segment degeneration in instrumented lumbar fusion. J Spinal Disord Tech 21(5):305–309

    Article  PubMed  Google Scholar 

  4. Bono CM, Bawa M, White KK, Mahar A, Vives M, Kauffman C et al (2008) Residual motion on flexion–extension radiographs after simulated lumbar arthrodesis in human cadavers. J Spinal Disord Tech 21(5):364–371

    Article  PubMed  Google Scholar 

  5. Korovessis P, Papazisis Z, Koureas G, Lambiris E (2004) Rigid, semirigid versus dynamic instrumentation for degenerative lumbar spinal stenosis: a correlative radiological and clinical analysis of short-term results. Spine 29(7):735–742

    Article  PubMed  Google Scholar 

  6. Nockels RP (2005) Dynamic stabilization in the surgical management of painful lumbar spinal disorders. Spine 30(16 Suppl):S68–S72

    Article  PubMed  Google Scholar 

  7. Sapkas GS, Themistocleous GS, Mavrogenis AF, Benetos IS, Metaxas N, Papagelopoulos PJ (2007) Stabilization of the lumbar spine using the dynamic neutralization system. Orthopedics 30(10):859–865

    PubMed  Google Scholar 

  8. Schwarzenbach O, Berlemann U, Stoll TM, Dubois G (2005) Posterior dynamic stabilization systems: DYNESYS. Orthop Clin North Am 36(3):363–372

    Article  PubMed  Google Scholar 

  9. 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–S178

  10. Rohlmann A, Burra NK, Zander T, Bergmann G (2007) Comparison of the effects of bilateral posterior dynamic and rigid fixation devices on the loads in the lumbar spine: a finite element analysis. Eur Spine J 16(8):1223–1231

    Article  PubMed  Google Scholar 

  11. Cheng BC, Gordon J, Cheng J, Welch WC (2007) Immediate biomechanical effects of lumbar posterior dynamic stabilization above a circumferential fusion. Spine 32(23):2551–2557

    Article  PubMed  Google Scholar 

  12. Bothmann M, Kast E, Boldt GJ, Oberle J (2008) Dynesys fixation for lumbar spine degeneration. Neurosurg Rev 31(2):189–196

    Article  PubMed  Google Scholar 

  13. 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(3):324–331

    Article  PubMed  Google Scholar 

  14. Bellini CM, Galbusera F, Raimondi MT, Mineo GV, Brayda-Bruno M (2007) Biomechanics of the lumbar spine after dynamic stabilization. J Spinal Disord Tech 20(6):423–429

    Article  PubMed  Google Scholar 

  15. Schmoelz W, Huber JF, Nydegger T, Claes L, Wilke HJ (2006) Influence of a dynamic stabilisation system on load bearing of a bridged disc: an in vitro study of intradiscal pressure. Eur Spine J 15(8):1276–1285

    Article  PubMed  CAS  Google Scholar 

  16. Freudiger S, Dubois G, Lorrain M (1999) Dynamic neutralisation of the lumbar spine confirmed on a new lumbar spine simulator in vitro. Arch Orthop Trauma Surg 119(3–4):127–132

    Article  PubMed  CAS  Google Scholar 

  17. Niosi CA, Zhu QA, Wilson DC, Keynan O, Wilson DR, Oxland TR (2006) Biomechanical characterization of the three-dimensional kinematic behaviour of the Dynesys dynamic stabilization system: an in vitro study. Eur Spine J 15(6):913–922

    Article  PubMed  Google Scholar 

  18. Schmoelz W, Huber JF, Nydegger T, Dipl-Ing ClaesL, Wilke HJ (2003) Dynamic stabilization of the lumbar spine and its effects on adjacent segments: an in vitro experiment. J Spinal Disord Tech 16(4):418–423

    PubMed  CAS  Google Scholar 

  19. Guehring T, Unglaub F, Lorenz H, Omlor G, Wilke HJ, Kroeber MW (2006) Intradiscal pressure measurements in normal discs, compressed discs and compressed discs treated with axial posterior disc distraction: an experimental study on the rabbit lumbar spine model. Eur Spine J 15(5):597–604

    Article  PubMed  Google Scholar 

  20. Beastall J, Karadimas E, Siddiqui M, Nicol M, Hughes J, Smith F et al (2007) The Dynesys lumbar spinal stabilization system: a preliminary report on positional magnetic resonance imaging findings. Spine 32(6):685–690

    Article  PubMed  Google Scholar 

  21. Putzier M, Schneider SV, Funk JF, Tohtz SW, Perka C (2005) The surgical treatment of the lumbar disc prolapse: nucleotomy with additional transpedicular dynamic stabilization versus nucleotomy alone. Spine 30(5):E109–E114

    Article  PubMed  Google Scholar 

  22. Chapman CR, Casey KL, Dubner R, Foley KM, Gracely RH, Reading AE (1985) Pain measurement: an overview. Pain 22(1):1–31

    Article  PubMed  CAS  Google Scholar 

  23. Fairbank JC, Couper J, Davies JB, O’Brien JP (1980) The Oswestry low back pain disability questionnaire. Physiotherapy 66(8):271–273

    PubMed  CAS  Google Scholar 

  24. Prolo DJ, Oklund SA, Butcher M (1986) Toward uniformity in evaluating results of lumbar spine operations. A paradigm applied to posterior lumbar interbody fusions. Spine 11(6):601–606

    Article  PubMed  CAS  Google Scholar 

  25. Pfirrmann CWA, Matzdorf A, Zanetti M, Hodler J, Boos N (2001) Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine 17:1873–1878

    Article  Google Scholar 

  26. Modic MT, Steinberg PM, Ross JS, Masaryk TJ, Carter JR (1988) Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology 166(1 Pt 1):193–199

    PubMed  CAS  Google Scholar 

  27. Vaga S, Raimondi MT, Caiani EG, Costa F, Giordano C, Perona F et al (2008) Quantitative assessment of intervertebral disc glycosaminoglycan distribution by gadolinium-enhanced MRI in orthopedic patients. Magn Reson Med 59(1):85–95

    Article  PubMed  Google Scholar 

  28. Paajanen H, Lehto I, Alanen A, Erkintalo M, Komu M (1994) Diurnal fluid changes of lumbar discs measured indirectly by magnetic resonance imaging. J Orthop Res 12(4):509–514

    Article  PubMed  CAS  Google Scholar 

  29. Battié MC, Videman T, Parent E (2004) Lumbar disc degeneration: epidemiology and genetic influences. Spine 29(23):2679–2690

    Article  PubMed  Google Scholar 

  30. Battié MC, Videman T (2006) Lumbar disc degeneration: epidemiology and genetics. J Bone Joint Surg Am 88(Suppl 2):3–9

    Article  PubMed  Google Scholar 

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Acknowledgments

Financial support by Zimmer GmbH (Winterthur, Switzerland) is gratefully acknowledged.

Conflict of interest statement

None of the authors has any potential conflict of interest.

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Authors and Affiliations

  1. IRCCS Istituto Ortopedico Galeazzi, via R. Galeazzi 4, 20126, Milan, Italy

    Stefania Vaga, M. Brayda-Bruno, F. Perona, M. Fornari, M. T. Raimondi, M. Petruzzi, G. Grava, F. Costa, E. G. Caiani & C. Lamartina

  2. Department of Structural Engineering, Politecnico di Milano, Milan, Italy

    M. T. Raimondi

  3. Department of Biomedical Engineering, Politecnico di Milano, Milan, Italy

    E. G. Caiani

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  1. Stefania Vaga
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  2. M. Brayda-Bruno
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  3. F. Perona
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  4. M. Fornari
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  5. M. T. Raimondi
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  6. M. Petruzzi
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  7. G. Grava
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  9. E. G. Caiani
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  10. C. Lamartina
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Correspondence to Stefania Vaga.

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Vaga, S., Brayda-Bruno, M., Perona, F. et al. Molecular MR imaging for the evaluation of the effect of dynamic stabilization on lumbar intervertebral discs. Eur Spine J 18 (Suppl 1), 40–48 (2009). https://doi.org/10.1007/s00586-009-0996-7

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  • DOI: https://doi.org/10.1007/s00586-009-0996-7

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