Zhang Chengmin, Wang Liyuan, Hou Tianyong, Luo Lei, Zhao Chen, Gan Yibo, Zhou Qiang, Li Pei
Department of Orthopedics, Southwest Hospital, Third Military Medical University, No. 29 GaoTanYan Street, Chongqing, 400038, China.
J Orthop Surg Res. 2017 Jun 26;12(1):99. doi: 10.1186/s13018-017-0597-9.
The aim of this study is to evaluate the efficacy of Dynesys® posterior dynamic stabilization (PDS) in the treatment of L4-S1 degenerative diseases and to assess the influence of postoperative motion on lumbar degeneration.
Included in this retrospective study were patients with L4-S1 degenerative disease who underwent fusion or PDS from September 2010 to September 2014. Clinical outcomes were assessed by preoperative and postoperative visual analog scale (VAS) and Oswestry Disability Index (ODI). Preoperative and postoperative X-rays assessed range of motion (ROM) of the non-surgical and surgical levels and whole lumbar. MRI assessed degeneration of non-surgical levels.
A total of 56 consecutive patients were divided into two groups: group A, PDS, and group B, fusion. Patient demographics and baseline characteristics were similar in the two groups. In both groups, there was a significant difference between preoperative and postoperative VAS and ODI scores (P < 0.05). However, there was a significant difference in a 6-month follow-up ODI between the two groups (P < 0.05). X-rays showed PDS patients partially maintained surgical level ROM and non-surgical level ROM increased less than in the fusion group. MRI showed adjacent segment degeneration (ASD) in both groups, and patients whose preoperative L3-4 Pfirrmann classification was higher than grade 2 had more ASD than lower than grade 2.
PDS can maintain surgical level ROM and had less influence on whole and non-surgical level ROM. Following PDS, patients recovered faster and had a better lumbar function. It may be a better choice for multi-level lumbar degenerative diseases.
本研究旨在评估Dynesys®后路动态稳定系统（PDS）治疗L4 - S1节段退行性疾病的疗效，并评估术后活动对腰椎退变的影响。
本回顾性研究纳入了2010年9月至2014年9月期间接受融合手术或PDS手术治疗的L4 - S1节段退行性疾病患者。通过术前和术后视觉模拟评分（VAS）及Oswestry功能障碍指数（ODI）评估临床疗效。术前和术后X线片评估非手术节段和手术节段以及整个腰椎的活动度（ROM）。MRI评估非手术节段的退变情况。
共56例连续患者被分为两组：A组为PDS组，B组为融合组。两组患者的人口统计学和基线特征相似。两组术前和术后VAS及ODI评分均有显著差异（P < 0.05）。然而，两组在术后6个月随访时的ODI有显著差异（P < 0.05）。X线片显示PDS组患者手术节段的ROM部分得以保留，且非手术节段ROM的增加幅度小于融合组。MRI显示两组均有相邻节段退变（ASD），术前L3 - 4 Pfirrmann分级高于2级的患者比低于2级的患者ASD更多。
PDS可维持手术节段的ROM，对整个腰椎及非手术节段的ROM影响较小。PDS术后患者恢复更快，腰椎功能更好。对于多节段腰椎退行性疾病，它可能是更好的选择。
