Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Neurosurg Focus. 2010 Jun;28(6):E2. doi: 10.3171/2010.3.FOCUS1055.
The authors report the use and preliminary results of a novel hybrid dynamic stabilization and fusion construct for the surgical treatment of degenerative lumbar spine pathology.
The authors performed a retrospective chart review of all patients who underwent posterior lumbar instrumentation with the Dynesys-to-Optima (DTO) hybrid dynamic stabilization and fusion system. Preoperative symptoms, visual analog scale (VAS) pain scores, perioperative complications, and the need for subsequent revision surgery were recorded. Each patient was then contacted via telephone to determine current symptoms and VAS score. Follow-up was available for 22 of 24 patients, and the follow-up period ranged from 1 to 22 months. Clinical outcome was gauged by comparing VAS scores prior to surgery and at the time of telephone interview.
A total of 24 consecutive patients underwent lumbar arthrodesis surgery in which the hybrid system was used for adjacent-level dynamic stabilization. The mean preoperative VAS score was 8.8, whereas the mean postoperative VAS score was 5.3. There were five perioperative complications that included 2 durotomies and 2 wound infections. In addition, 1 patient had a symptomatic medially placed pedicle screw that required revision. These complications were not thought to be specific to the DTO system itself. In 3 patients treatment failed, with treatment failure being defined as persistent preoperative symptoms requiring reoperation.
The DTO system represents a novel hybrid dynamic stabilization and fusion construct. The technique holds promise as an alternative to multilevel lumbar arthrodesis while potentially decreasing the risk of adjacent-segment disease following lumbar arthrodesis. The technology is still in its infancy and therefore follow-up, when available, remains short. The authors report their preliminary experience using a hybrid system in 24 patients, along with short-interval clinical and radiographic follow-up.
作者报告了一种新型混合动态稳定和融合结构在退行性腰椎病变的外科治疗中的应用及初步结果。
作者对所有接受后路腰椎器械固定加 Dynesy 至 Optima（DTO）混合动态稳定和融合系统治疗的患者进行了回顾性图表审查。记录术前症状、视觉模拟评分（VAS）疼痛评分、围手术期并发症以及是否需要后续翻修手术。然后通过电话联系每位患者，以确定当前症状和 VAS 评分。24 例患者中有 22 例获得随访，随访时间为 1 至 22 个月。通过比较术前和电话访谈时的 VAS 评分来评估临床结果。
共有 24 例连续患者接受了腰椎融合手术，其中混合系统用于相邻节段的动态稳定。平均术前 VAS 评分为 8.8，而平均术后 VAS 评分为 5.3。有 5 例围手术期并发症，包括 2 例硬脊膜切开术和 2 例伤口感染。此外，1 例患者出现症状性内侧置钉，需要翻修。这些并发症被认为不是 DTO 系统本身特有的。在 3 例患者中治疗失败，治疗失败的定义为术前症状持续存在需要再次手术。
DTO 系统代表了一种新型混合动态稳定和融合结构。该技术有望成为多节段腰椎融合术的替代方法，同时降低腰椎融合术后相邻节段疾病的风险。该技术仍处于起步阶段，因此，当可用时，随访时间仍然较短。作者报告了他们在 24 例患者中使用混合系统的初步经验，以及短期的临床和影像学随访。
