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Skipping Posterior Dynamic Transpedicular Stabilization for Distant Segment Degenerative Disease

DOI: 10.1155/2012/496817

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Objective. To date, there is still no consensus on the treatment of spinal degenerative disease. Current surgical techniques to manage painful spinal disorders are imperfect. In this paper, we aimed to evaluate the prospective results of posterior transpedicular dynamic stabilization, a novel surgical approach that skips the segments that do not produce pain. This technique has been proven biomechanically and radiologically in spinal degenerative diseases. Methods. A prospective study of 18 patients averaging 54.94 years of age with distant spinal segment degenerative disease. Indications consisted of degenerative disc disease (57%), herniated nucleus pulposus (50%), spinal stenosis (14.28%), degenerative spondylolisthesis (14.28%), and foraminal stenosis (7.1%). The Oswestry Low-Back Pain Disability Questionnaire and visual analog scale (VAS) for pain were recorded preoperatively and at the third and twelfth postoperative months. Results. Both the Oswestry and VAS scores showed significant improvement postoperatively ( ). We observed complications in one patient who had spinal epidural hematoma. Conclusion. We recommend skipping posterior transpedicular dynamic stabilization for surgical treatment of distant segment spinal degenerative disease. 1. Introduction The most frequent clinical problem of the adult spine is back pain. It is known that 60–80% of the population will have back pain at some point in their lives that may affect their general health, daily activities, and their working capacity. It is assumed that back pain only has a defined pathology in 15% of patients [1], and dysfunctional segmental motion and discogenic pain are problems that may need to be treated surgically. According to Bertagnoli, disc-related spinal problems could be treated because of the state of degenerative segmental alterations [2]. Those at an earlier stage of disc degeneration may respond to the conservative treatment. More advanced disc degeneration may require open-disc surgery, especially concomitant nerve root compression. Fusion surgery is usually indicated in more advanced segmental degeneration. Discectomy and fusion are performed with the aim of reducing pain and eliminating neural compression rather than restoring disc or segmental function. Researchers have demonstrated the benefits of fusion over nonsurgical treatment in the alleviation of chronic low-back pain [3, 4]. Although studies have shown improvements in the instrumentation techniques that have increased the radiological fusion rate to >94%, they have failed to provide evidence of actual

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