All Title Author
Keywords Abstract

Skipping Posterior Dynamic Transpedicular Stabilization for Distant Segment Degenerative Disease

DOI: 10.1155/2012/496817

Full-Text   Cite this paper   Add to My Lib


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


[1]  G. Waddell, “Diagnostic triage,” in The Back Pain Revolution, G. Waddell, Ed., pp. 9–26, Churcill Livingstone, Edinburgh, UK, 2004.
[2]  R. Bertagnoli, “Review of modern treatment options for degenerative disc disease,” in Spinal Restabilization Procedures, D. L. Kaech and J. R. Jinkins, Eds., pp. 365–375, Elsevier Science, Amsterdam, The Netherlands, 2002.
[3]  F. H. Albee, “Transportation of a portion of the tibia into the spine for Pott's disease,” Journal of the American Medical Association, vol. 57, p. 885, 1911.
[4]  P. Fritzell, O. H?gg, P. Wessberg, and A. Nordwall, “2001 Volvo award winner in clinical studies: lumbar fusion versus nonsurgical treatment for chronic low back pain. A multicenter randomized controlled trial from the Swedish Lumbar Spine Study Group,” Spine, vol. 26, no. 23, pp. 2521–2534, 2001.
[5]  C. K. Lee, P. Vessa, June Kyu Lee, and S. Wiesel, “Chronic disabling low back pain syndrome caused by internal disc derangements: the results of disc excision and posterior lumbar interbody fusion,” Spine, vol. 20, no. 3, pp. 356–361, 1995.
[6]  J. C. Eck, S. C. Humphreys, and S. D. Hodges, “Adjacent-segment degeneration after lumbar fusion: a review of clinical, biomechanical, and radiologic studies.,” American journal of orthopedics, vol. 28, no. 6, pp. 336–340, 1999.
[7]  N. Bogduk, “The innervation of the lumbar spine,” Spine, vol. 8, no. 3, pp. 286–293, 1983.
[8]  W. H. Kirkaldy-Willis and H. F. Farfan, “Instability of the lumbar spine,” Clinical Orthopaedics and Related Research, vol. 165, pp. 110–123, 1982.
[9]  K. Abumi, M. M. Panjabi, K.M. Kramer, J. Duranceau, T. Oxland, and J. J. Crisco, “Biomechanical evaluation of lumbar spinal stability after graded facetectomies,” Spine, vol. 15, no. 11, pp. 1142–1147, 1990.
[10]  K. Abumi, M. M. Panjabi, K. M. Kramer, J. Duranceau, T. Oxland, and J. J. Crisco, “Biomechanical evaluation of lumbar spinal stability after graded facetectomies,” Spine, vol. 15, no. 11, pp. 1142–1147, 1990.
[11]  S. D. Boden, C. Martin, R. Rudolph, J. S. Kirkpatrick, S. M. R. Moeini, and W. C. Hutton, “Increase of motion between lumbar vertebrae after excision of the capsule and cartilage of the facets. A cadaver study,” Journal of Bone and Joint Surgery A, vol. 76, no. 12, pp. 1847–1853, 1994.
[12]  J. W. Frymoyer and D. K. Selby, “Segmental instability: rationale for treatment,” Spine, vol. 10, no. 3, pp. 280–286, 1985.
[13]  B. J?nsson, M. Akesson, K. Jonsson, and B. Stromqvist, “Low risk for vertebral slipping after decompression with facet joint preserving technique for lumbar spinal stenosis,” European Spine Journal, vol. 1, no. 2, pp. 100–104, 1992.
[14]  R. H. Hibbs, “An operation for progressive spinal deformities,” New York Medical Journal, vol. 93, pp. 10–13, 1911.
[15]  S. Agazzi, A. Reverdin, and D. May, “Posterior lumbar interbody fusion with cages: an independent review of 71 cases,” Journal of Neurosurgery, vol. 91, no. 2, pp. 186–192, 1999.
[16]  F. B. Christensen, E. Stender Hansen, M. Laursen, K. Thomsen, and C. E. Bünger, “Long-term functional outcome of pedicle screw instrumentation as a support for posterolateral spinal fusion: randomized clinical study with a 5-year follow-up,” Spine, vol. 27, no. 12, pp. 1269–1277, 2002.
[17]  J. S. Fischgrund, M. Mackay, H. N. Herkowitz, R. Brower, D. M. Montgomery, and L. T. Kurz, “Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective, randomized study comparing decompressive laminectomy and arthrodesis with and without spinal instrumentation,” Spine, vol. 22, no. 24, pp. 2807–2812, 1997.
[18]  P. Fritzell, O. H?gg, P. Wessberg, and A. Nordwall, “Chronic low back pain and fusion: a comparison of three surgical techniques: a prospective multicenter randomized study from the Swedish Lumbar Spine Study Group,” Spine, vol. 27, no. 11, pp. 1131–1141, 2002.
[19]  Y. Kotani, B. W. Cunningham, A. Cappuccino, K. Kaneda, and P. C. McAfee, “The effects of spinal fixation and destabilization on the biomechanical and histologic properties of spinal ligaments: an in vivo study,” Spine, vol. 23, no. 6, pp. 672–683, 1998.
[20]  C. S. Chen, C. K. Feng, C. K. Cheng, M. J. Tzeng, C. L. Liu, and W. J. Chen, “Biomechanical analysis of the disc adjacent to posterolateral fusion with laminectomy in lumbar spine,” Journal of Spinal Disorders and Techniques, vol. 18, no. 1, pp. 58–65, 2005.
[21]  P. Fritzell, O. H?gg, P. Wessberg, and A. Nordwall, “2001 Volvo award winner in clinical studies: lumbar fusion versus nonsurgical treatment for chronic low back pain. A multicenter randomized controlled trial from the Swedish Lumbar Spine Study Group,” Spine, vol. 26, no. 23, pp. 2521–2534, 2001.
[22]  J. N. A. Gibson, I. C. Grant, and G. Waddell, “The Cochrane review of surgery for lumbar disc prolapse and degenerative lumbar spondylosis,” Spine, vol. 24, no. 17, pp. 1820–1832, 1999.
[23]  J. Glaser, M. Stanley, H. Sayre, J. Woody, E. Found, and K. Spratt, “A 10-year follow-up evaluation of lumbar spine fusion with pedicle screw fixation,” Spine, vol. 28, no. 13, pp. 1390–1395, 2003.
[24]  P. V. Mummaneni, R. W. Haid, and G. E. Rodts, “Lumbar interbody fusion: state-of-the-art technical advances,” Journal of Neurosurgery, vol. 101, no. 1, pp. 24–30, 2004.
[25]  O. Schwarzenbach, U. Berlemann, T. M. Stoll, and G. Dubois, “Posterior dynamic stabilization systems: Dynesys,” Orthopedic Clinics of North America, vol. 36, no. 3, pp. 363–372, 2005.
[26]  T. R. Lehmann, K. F. Spratt, and J. E. Tozzi, “Long-term follow-up of lower lumbar fusion patients,” Spine, vol. 12, no. 2, pp. 97–104, 1987.
[27]  G. Ghiselli, J. C. Wang, N. N. Bhatia, W. K. Hsu, and E. G. Dawson, “Adjacent segment degeneration in the lumbar spine,” Journal of Bone and Joint Surgery A, vol. 86, no. 7, pp. 1497–1503, 2004.
[28]  R. C. Huang, F. P. Girardi, M. R. Lim, and F. P. Cammisa Jr, “Advantages and disadvantages of nonfusion technology in spine surgery,” Orthopedic Clinics of North America, vol. 36, no. 3, pp. 263–269, 2005.
[29]  R. C. Huang, T. M. Wright, M. M. Panjabi, and J. D. Lipman, “Biomechanics of nonfusion implants,” Orthopedic Clinics of North America, vol. 36, no. 3, pp. 271–280, 2005.
[30]  S. Inceoglu, “Posterior dynamic stabilization of the lumbar spine,” World Spine Journal, vol. 1, pp. 62–67, 2006.
[31]  H. Ishihara, R. Osada, M. Kanamori et al., “Minimum 10-year follow-up study of anterior lumbar interbody fusion for isthmic spondylolisthesis,” Journal of Spinal Disorders, vol. 14, no. 2, pp. 91–99, 2001.
[32]  T. M. Stoll, G. Dubois, and O. Schwarzenbach, “The dynamic neutralization system for the spine: a multi-center study of a novel non-fusion system,” European Spine Journal, vol. 11, supplement 2, pp. S170–S178, 2002.
[33]  M. Sasani, A. L. Aydin, T. Oktenoglu et al., “The combined use of a posterior dynamic transpedicular stabilization system and a prosthetic disc nucleus device in treating lumbar degenerative disc disease with disc herniations,” SAS Journal, vol. 2, no. 3, pp. 130–136, 2008.
[34]  A. Strempel, A. Neckritz, P. Mualenaere, and G. du Toit, “Dynamic versus rigid spinal implants,” in Lumbar Spinal Stenosis, R. Gunzburg and M. Szpalski, Eds., pp. 275–285, Lippincott-Williams and Wilkins, Philadelphia, Pa, USA, 2000.
[35]  M. Putzier, S. V. Schneider, J. F. Funk, S. W. Tohtz, and C. Perka, “The surgical treatment of the lumbar disc prolapse: nucleotomy with additional transpedicular dynamic stabilization versus nucleotomy alone.,” Spine., vol. 30, no. 5, pp. E109–E114, 2005.
[36]  H. Frei, T. R. Oxland, G. C. Rathonyi, and L. P. Nolte, “The effect of nucleotomy on lumbar spine mechanics in compression and shear loading,” Spine, vol. 26, no. 19, pp. 2080–2089, 2001.
[37]  O. L. Osti, B. Vernon-Roberts, and R. D. Fraser, “1990 Volvo award in experimental studies: anulus tears and intervertebral disc degeneration: an experimental study using an animal model,” Spine, vol. 15, no. 8, pp. 762–767, 1990.
[38]  M. D. Rahm and B. B. Hall, “Adjacent-segment degeneration after lumbar fusion with instrumentation: a retrospective study,” Journal of Spinal Disorders, vol. 9, no. 5, pp. 392–400, 1996.
[39]  J. Zucherman, K. Hsu, G. Picetti, A. White, G. Wynne, and L. Taylor, “Clinical efficacy of spinal instrumentation in lumbar degenerative disc disease,” Spine, vol. 17, no. 7, pp. 834–837, 1992.
[40]  K. E. Johnsson, S. Willner, and K. Johnsson, “Postoperative instability after decompression for lumbar spinal stenosis,” Spine, vol. 11, no. 2, pp. 107–110, 1986.
[41]  E. Kotilainen, A. Alanen, M. Erkintalo, S. Valtonen, and M. Kormano, “Association between decreased disc signal intensity in T2-weighted MRI and a 5-year outcome after lumbar minimally invasive discectomy association between decreased disc signal intensity in preoperative,” Minimally Invasive Neurosurgery, vol. 44, no. 1, pp. 31–36, 2001.
[42]  T. Kaner, S. Dalbayrak, T. Oktenoglu, M. Sasani, A. L. Aydin, and F. O. Ozer, “Comparison of posterior dynamic and posterior rigid transpedicular stabilization with fusion to treat degenerative spondylolisthesis,” Orthopedics, vol. 33, no. 5, p. 12, 2010.
[43]  H. Bassewitz and H. Herkowitz, “Lumbar stenosis with spondylolisthesis: current concepts of surgical treatment,” Clinical Orthopaedics and Related Research, no. 384, pp. 54–60, 2001.
[44]  H. L. Feffer, S. W. Wiesel, J. M. Cuckler, and R. H. Rothman, “Degenerative spondylolisthesis: to fuse or not to fuse,” Spine, vol. 10, no. 3, pp. 287–289, 1985.
[45]  H. N. Herkowitz and L. T. Kurz, “Degenerative lumbar spondylolisthesis with spinal stenosis: a prospective study comparing decompression with decompression and intertransverse process arthrodesis,” Journal of Bone and Joint Surgery A, vol. 73, no. 6, pp. 802–808, 1991.
[46]  J. S. Lombardi, L. L. Wiltse, and J. Reynolds, “Treatment of degenerative spondylolisthesis,” Spine, vol. 10, no. 9, pp. 821–827, 1985.
[47]  R. J. Nasca, “Rationale for spinal fusion in lumbar spinal stenosis,” Spine, vol. 14, no. 4, pp. 451–454, 1989.
[48]  S. E. Nork, S. S. Hu, K. L. Workman, P. A. Glazer, and D. S. Bradford, “Patient outcomes after decompression and instrumented posterior spinal fusion for degenerative spondylolisthesis,” Spine, vol. 24, no. 6, pp. 561–569, 1999.
[49]  K. C. Booth, K. H. Bridwell, B. A. Eisenberg, C. R. Baldus, and L. G. Lenke, “Minimum 5-year results of degenerative spondylolisthesis treated with decompression and instrumented posterior fusion,” Spine, vol. 24, no. 16, pp. 1721–1727, 1999.
[50]  K. H. Bridwell, T. A. Sedgewick, M. F. O'Brien, L. G. Lenke, and C. Baldus, “The role of fusion and instrumentation in the treatment of degenerative spondylolisthesis with spinal stenosis,” Journal of Spinal Disorders, vol. 6, no. 6, pp. 461–472, 1993.
[51]  J. N. Gibson, G. Waddell, and I. C. Grant, “Surgery for degenerative lumbar spondylosis.,” Cochrane Database of Systematic Reviews, no. 3, p. CD001352, 2000.
[52]  F. Postacchini, G. Cinotti, and D. Perugia, “Degenerative lumbar spondylolisthesis. II. Surgical treatment.,” Italian Journal of Orthopaedics and Traumatology, vol. 17, no. 4, pp. 467–477, 1991.
[53]  J. C. Banwart, M. A. Asher, and R. S. Hassanein, “Iliac crest bone graft harvest donor site morbidity: a statistical evaluation,” Spine, vol. 20, no. 9, pp. 1055–1060, 1995.
[54]  E. M. Younger and M. W. Chapman, “Morbidity at bone graft donor sites,” Journal of orthopaedic trauma, vol. 3, no. 3, pp. 192–195, 1989.
[55]  B. Cakir, B. Ulmar, H. Koepp, K. Huch, W. Puhl, and M. Richter, “Posterior dynamic stabiliziation as on alternative for instrumented fusion in the treatment of degenerative lumbar instability with spinal stenosis,” Zeitschrift fur Orthopadie und Ihre Grenzgebiete, vol. 141, no. 4, pp. 418–424, 2003.
[56]  W. Schmoelz, J. F. Huber, T. Nydegger, Dipl-Ing, L. Claes, and H. J. Wilke, “Dynamic stabilization of the lumbar spine and its effects on adjacent segments: an in vitro experiment,” Journal of Spinal Disorders and Techniques, vol. 16, no. 4, pp. 418–423, 2003.
[57]  K. J. Schnake, S. Schaeren, and B. Jeanneret, “Dynamic stabilization in addition to decompression for lumbar spinal stenosis with degenerative spondylolisthesis,” Spine, vol. 31, no. 4, pp. 442–449, 2006.
[58]  A. F. Ozer, T. Oktenoglu, M. Sasani et al., “Preserving the ligamentum flavum in lumbar discectomy: a new technique that prevents scar tissue formation in the first 6 months postsurgery,” Neurosurgery, vol. 59, supplement 1, pp. S-126–S-133, 2006.


comments powered by Disqus