Hybrid dynamic stabilization with posterior spinal fusion in the lumbar spine.
Hybrid dynamic stabilization with posterior spinal fusion in the lumbar spine.
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DOI：
10.1016/j.esas.2011.01.003
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发表时间：
2011
期刊：
影响因子：
--
通讯作者：
Castellvi AE
中科院分区：
文献类型：
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作者：
Hudson WR;Gee JE;Billys JB;Castellvi AE
内固定腰椎关节融合术已被确立为退行性椎间盘疾病患者护理的金标准。然而，脊柱融合导致功能性脊柱单位运动的消除，并与相邻节段退变的发展有关。动态棒等运动保留器械可稳定融合节段上方的病理性运动节段，并创建一个过渡区（指数节段），以减少施加到上相邻正常节段的载荷。在机构审查委员会批准后，28例患者被纳入这项前瞻性、连续性、非随机临床试验。每例受试者均同意进行动态稳定。没有尝试在动态水平上进行融合。该队列接受了后路外侧脊柱融合术，使用椎间融合器进行单节段或双节段经椎间孔腰椎椎间融合术，并采用上节段后路动态内固定。功能性临床结局采用100分视觉模拟量表、奥斯韦斯特里残疾指数和简明36问卷进行测量。记录影像学测量、融合评价、并发症和螺钉松动。至少24个月的随访数据包括22例患者。未发现器械失效或螺钉断裂。术后平均活动度为2.5°，相邻节段的上级活动度保持不变（P > 0.05）。所有节段的椎间盘高度均保持不变（P > 0.05）。在180枚螺钉中，6枚（3%）显示影像学松动。功能结局显示，从基线到2年随访，平均术后视觉模拟量表评分显著改善24.7分（P <0.01），奥斯韦斯特里残疾指数显著改善27.6分（P <0.01），简表36身体（P <0.01）和精神（P <0.05）部分也显著改善。两年的初步结果令人满意。最终，进一步的随访将评估这种治疗在长期内延迟相邻节段变化的潜力。
Instrumented lumbar arthrodesis has been established as the gold standard in the care of patients with degenerative disc disease. However, spinal fusion results in the elimination of motion of the functional spinal unit and has been implicated in the development of adjacent-level degeneration. Motion-preserving devices such as the dynamic rod allow for stabilization of a pathologic motion segment above a fused segment and create a transitional zone (index level) that decreases the loads applied to the supra-adjacent normal segment. After institutional review board approval, 28 patients were included in this prospective, consecutive, nonrandomized clinical trial. Each subject was consented for dynamic stabilization. There was no attempt at fusion at the dynamic level. The cohort underwent a posterior lateral spinal fusion with single- or 2-level transforaminal lumbar interbody fusion by use of a cage, with superior-level posterior dynamic instrumentation. Functional clinical outcomes were measured with a 100-point visual analog scale, Oswestry Disability Index, and Short Form 36 questionnaire. Radiographic measurements, fusion evaluation, complications, and screw loosening were recorded. A minimum of 24 months’ follow-up data included 22 patients. No device failure or screw breakage was identified. Postoperative range of motion averaged 2.5° at the index level, and the superior adjacent-level range of motion remained unchanged (P > .05). Disc height was preserved at all levels (P > .05). Of 180 screws, 6 (3%) showed radiographic loosening. Functional outcomes showed significant improvement in mean postoperative visual analog scale score by 24.7 points (P < .01) and Oswestry Disability Index by 27.6 points (P < .01), as well as the Short Form 36 physical (P < .01) and mental (P < .05) components from baseline to 2-year follow-up. Our preliminary results at 2 years are satisfactory. Ultimately, further follow-up will assess the potential for this treatment to delay adjacent-level changes in the long term.