Khalifa Ahmed Hosny, Stübig Timo, Meier Oliver, Müller Christian Walter
Trauma Department, Hannover Medical School (MHH), Hannover.
Spine Center, Werner-Wicker-Clinic, Bad Wildungen, Germany.
Orthop Rev (Pavia). 2018 Apr 4;10(1):7534. doi: 10.4081/or.2018.7534. eCollection 2018 Mar 29.
Following lumbar fusion, adjacent segment degeneration has been frequently reported. Dynamic systems are believed to reduce main fusion drawbacks. We conducted a retrospective study on patients with degenerative lumbar disease treated with posterior dynamic stabilization with monoaxial hinged pedicular screws and lumbar decompression. VAS and ODI were used to compare clinical outcomes. As radiological outcomes, LL and SVA were used. 51 patients were included with an average follow-up of 24 months. 13 patients were revised because of postoperative radiculopathy (n=4), subcutaneous hematoma (n=2), L5 screw malposition (n=1) and adjacent segment disease (n=6). The mean ODI score 41 preoperatively compared to 36 postoperatively. The mean VAS scores for back and leg pain were 5.3 and 4.2, respectively compared to 4.5 and 4.0 postoperatively. The mean SVA was 5.3 cm preoperatively, and 5.7 cm postoperatively. The mean LL was 47.5° preoperatively and 45.5° postoperatively. From our data, which fail to show significant improvements and reflect a high revision rate, we cannot generally recommend dynamic stabilization as an alternative to fusion. Comparative trials with longer follow-ups are required.
腰椎融合术后,相邻节段退变屡有报道。动力系统被认为可减少融合术的主要弊端。我们对采用单轴铰链式椎弓根螺钉进行后路动力稳定和腰椎减压治疗的退行性腰椎疾病患者进行了一项回顾性研究。采用视觉模拟评分法(VAS)和腰椎功能障碍指数(ODI)比较临床疗效。腰椎前凸(LL)和矢状面垂直轴(SVA)作为影像学疗效指标。纳入51例患者,平均随访24个月。13例患者因术后神经根病(n = 4)、皮下血肿(n = 2)、L5螺钉位置不当(n = 1)和相邻节段疾病(n = 6)进行了翻修手术。术前平均ODI评分为41分,术后为36分。术前背部和腿部疼痛的平均VAS评分分别为5.3和4.2,术后分别为4.5和4.0。术前平均SVA为5.3 cm,术后为5.7 cm。术前平均LL为47.5°,术后为45.5°。根据我们的数据,未能显示出显著改善且翻修率较高,我们一般不推荐将动力稳定作为融合术的替代方法。需要进行随访时间更长的对比试验。