Abstract
Postero-lateral fusion by means of rod-and-screws/hooks constructs is still the gold standard in the treatment of lumbar degenerative spinal diseases. However, fusion remains fraught with a high risk of adjacent levels degeneration, sometimes leading to suboptimal clinical outcomes. Dynamic stabilization is supposed to compensate for disadvantages associated with rigid fusion. Preliminary results of spinal stabilization by means of dynamic devices show encouraging results. Therefore, the aim of the present study is to retrospectively evaluate the overall long term outcome and the condition of the adjacent discs to fused segments in an active population of 33 patients with back pain associated with lumbar instability, who underwent postero-lateral dynamic stabilization by means of a dynamic rod-and-screws construct, without fusion. The mean follow-up was 45 months. Clinical and radiological data, pain, function, return to work rate and patient satisfaction index were recorded to assess the overall patient outcome. The results show a very low rate of post-operative complications. No spontaneous fusion was noted in any patient. Pain, both lumbar and radicular, was totally relieved in most of the patients and the functional results were good or excellent in 76% of patients. Most of the patients resumed their previous activities; the return to previous work rate was 87.5%. Ninety-four percent of the patients were fully satisfied with the results. The preservation of both instrumented levels and the adjacent ones was observed in 90% of patients. Although the present series is rather limited in number, the results of the study are encouraging and in agreement with most findings in the literature. As the results are sustained at a mid and long term, the authors believe that the stabilization without fusion by means of semi-rigid/dynamic systems is an interesting alternative to classical fusion as long as the indications are strictly defined.
Résumé
L’ostéosynthèse postéro-latérale à l’aide d’instrumentations avec vis et tiges est aujourd’hui encore le principal traitement chirurgical des pathologies lombaires dégénératives. Néanmoins, l’arthrodèse instrumentée est souvent associée par un risque non négligeable de dégénérescence discale aux niveaux adjacents se traduisant parfois par des résultats cliniques médiocres. La stabilisation dynamique devrait palier les inconvénients de l’arthrodèse et les résultats préliminaires de la littératures montrent que les différentes techniques sont assez prometteuses. Le but de cette étude est d’évaluer rétrospectivement à long terme le résultat global et l’état des disques aux niveaux instrumentés et aux niveaux adjacents dans une population de 33 patients souffrant de lombalgies associées avec une instabilité d’origine dégénérative ayant subi une stabilisation par voie postéro-latérale à l’aide d’une instrumentation dynamique type vis et tiges. Le suivi moyen de cette population a été de 45 mois. Les données cliniques et radiologiques, la douleur, l’aspect fonctionnel, le retour au travail et la satisfaction des patients ont été analysés pour évaluer le résultat global. Les résultats de l’étude montrent peu de complications post-opératoires, sans aucune fusion spontanée dans cette série. La douleur lombaire et radiculaire a été soulagé complètement dans la plupart des patients et les résultats fonctionnels étaient bon ou excellents pour 76% des patients. La plupart des patients ont repris leurs activités habituelles et le taux de reprise du même travail a été de 87,5%. 94% des patients étaient totalement satisfaits du résultat de la chirurgie. La préservation des niveaux discaux instrumentés et des niveaux adjacents a été constatée dans 90% des patients. Même si la série d’étude est relativement limitée en nombre, les résultats sont très encourageants et en parfait accord avec les données de la littérature. Comme les résultats semblent se maintenir dans le temps, à moyen et long terme, les auteurs concluent que la stabilisation dynamique sans fusion à l’aide d’instrumentations dynamiques type vis et tiges peut être considérée comme une alternative intéressante à l’arthrodèse tant que les indications sont clairement définies et respectées.
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Benezech, J., Mitulescu, A. Retrospective patient outcome evaluation after semi-rigid stabilization without fusion for degenerative lumbar instability. Eur J Orthop Surg Traumatol 17, 227–234 (2007). https://doi.org/10.1007/s00590-006-0186-9
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DOI: https://doi.org/10.1007/s00590-006-0186-9