Medical School of Chinese People's Liberation Army, Beijing 100853; Department of Orthopedics, Army General Hospital of Chinese People's Liberation Army, Beijing 100700, China.
Department of Orthopedics, Army General Hospital of Chinese People's Liberation Army, Beijing 100700, China.
Chin Med J (Engl). 2018 Nov 5;131(21):2537-2543. doi: 10.4103/0366-6999.244107.
Many clinical studies over the past decade have indicated positive outcomes for patients treated with Dynesys dynamic stabilization for lumbar degenerative disease. However, long-term outcomes of Dynesys for lumbar spinal stenosis are rarely reported. The aim of this study was to analyze the long-term clinical and radiologic outcomes for patients with lumbar spinal stenosis treated with Dynesys stabilization.
Thirty-eight patients with lumbar spinal stenosis were treated with Dynesys stabilization from July 2008 to March 2010. The minimal duration of follow-up was 72 months. The patients were divided into stenosis and spondylolisthesis groups according to degenerative spondylolisthesis. Clinical outcomes were evaluated using the Oswestry Disability Index (ODI) and visual analog scale (VAS). Radiographic evaluations included range of motion (ROM) and the disc heights of stabilized segments and the upper adjacent segments. We also evaluated the occurrence of radiographic and symptomatic adjacent segment degeneration (ASD).
There were 23 patients in stenosis group and 15 patients in spondylolisthesis group. The ODI scores were significantly improved at the final follow-up evaluation, as compared to the baseline values (16.1 ± 5.7 vs. 57. 2 ± 14.2, t = 61.41, P < 0.01). The VAS scores for back and leg pain were significantly improved from 4.82 ± 0.89 and 4.04 ± 0.82 preoperatively to 0.93 ± 0.61 and 0.54 ± 0.51 postoperatively (t = 6.59, P < 0.01, and t = 5.91, P < 0.01, respectively). There were no differences between the two groups with respect to VAS and ODI scores. The ROM of stabilized segments decreased significantly from 7.8° ± 2.4° to 4.5° ± 1.5° (t = 7.18, P < 0.05), while the upper adjacent segments increased significantly from 8.3° ± 2.4° to 10.4° ± 2.4° (t = 2.87, P = 0.01). The change in disc height of stabilized segments was not significant (11.9 ± 2.1 preoperatively vs. 12.5 ± 1.5 postoperatively, t = 1.43, P = 0.15), whereas the decrease in disc height of the upper adjacent segments was significant (12.5 ± 2.0 preoperatively vs. 11.0 ± 1.7 postoperatively, t = 2.94, P = 0.01). The occurrence of radiographic and symptomatic ASD was 16% (6/38) and 3% (1/38), respectively.
Decompression and Dynesys stabilization for lumbar stenosis with or without spondylolisthesis showed good long-term clinical and radiographic results. Lumbar stenosis with or without Grade I spondylolisthesis, particularly in patients <60 years of age with mild-to-moderate lumbar disc degeneration, would be one of the main indications for the Dynesys system.
过去十年的许多临床研究表明，接受 Dynesys 动力稳定治疗的腰椎退行性疾病患者有良好的治疗效果。然而，Dynesys 治疗腰椎管狭窄症的长期疗效鲜有报道。本研究旨在分析采用 Dynesys 稳定系统治疗腰椎管狭窄症患者的长期临床和影像学结果。
2008 年 7 月至 2010 年 3 月，38 例腰椎管狭窄症患者接受了 Dynesys 稳定治疗。最短随访时间为 72 个月。根据退行性腰椎滑脱，将患者分为狭窄组和滑脱组。临床结果采用 Oswestry 功能障碍指数（ODI）和视觉模拟评分（VAS）进行评估。影像学评估包括运动范围（ROM）以及稳定节段和上位相邻节段的椎间盘高度。我们还评估了影像学和症状性相邻节段退变（ASD）的发生情况。
狭窄组 23 例，滑脱组 15 例。与基线值相比，终末随访时 ODI 评分显著改善（16.1±5.7 比 57.2±14.2，t=61.41，P<0.01）。术后腰痛和腿痛的 VAS 评分分别从术前的 4.82±0.89 和 4.04±0.82 显著改善至术后的 0.93±0.61 和 0.54±0.51（t=6.59，P<0.01，和 t=5.91，P<0.01）。两组间 VAS 和 ODI 评分无差异。稳定节段的 ROM 从术前的 7.8°±2.4°显著减少至术后的 4.5°±1.5°（t=7.18，P<0.05），而上位相邻节段的 ROM 从术前的 8.3°±2.4°显著增加至术后的 10.4°±2.4°（t=2.87，P=0.01）。稳定节段椎间盘高度的变化不显著（术前 11.9±2.1 比术后 12.5±1.5，t=1.43，P=0.15），而上位相邻节段椎间盘高度的减少则显著（术前 12.5±2.0 比术后 11.0±1.7，t=2.94，P=0.01）。影像学和症状性 ASD 的发生率分别为 16%（6/38）和 3%（1/38）。
腰椎管狭窄症减压联合 Dynesys 稳定治疗无论是否合并滑脱均有良好的长期临床和影像学结果。有或没有 I 度滑脱的腰椎管狭窄症，特别是年龄<60 岁、伴轻至中度腰椎间盘退变的患者，是 Dynesys 系统的主要适应证之一。
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