Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital and West China School of Medicine, Sichuan University, Chengdu, China.
Orthop Surg. 2024 Apr;16(4):912-920. doi: 10.1111/os.14025. Epub 2024 Mar 6.
The Isobar TTL dynamic fixation system has demonstrated favorable outcomes in the short-term treatment of lumbar degenerative disc diseases (LDDs). However, there is a paucity of extensive research on the long-term effects of this system on LDDs. This study aimed to evaluate the long-term clinical and radiological outcomes of patients with LDDs who underwent treatment utilizing the Isobar TTL dynamic fixation system.
The study analyzed the outcomes of 40 patients with LDDs who underwent posterior lumbar decompression and received single-segment Isobar TTL dynamic internal fixation at our hospital between June 2010 and December 2016. The evaluation of clinical therapeutic effect involved assessing postoperative pain levels using the visual analogue scale (VAS) and Oswestry disability index (ODI), both before surgery, 3 months after, and the final follow-up. To determine the preservation of functional motion in dynamically stable segments, we measured the range of motion (ROM) and disc height of stabilized and adjacent segments preoperatively and during the final follow-up. Additionally, we investigated the occurrence of adjacent segment degeneration (ASD).
Forty patients were evaluated, with an average age of 44.65 years and an average follow-up period of 79.37 months. Fourteen patients belonged to the spondylolisthesis group, while the remaining 26 were categorized under the stenosis or herniated disc group. The preoperative ROM of the stabilized segment exhibited a significant reduction from 8.15° ± 2.77° to 5.00° ± 1.82° at the final follow-up (p < 0.001). In contrast, there was a slight elevation in the ROM of the adjacent segment during the final follow-up, increasing from 7.68° ± 2.25° before surgery to 9.36° ± 1.98° (p < 0.001). The intervertebral space height (IH) in the stabilized segment exhibited a significant increase from 10.56 ± 1.99 mm before surgery to 11.39 ± 1.90 mm at the one-week postoperative follow-up (p < 0.001). Conversely, there was a notable decrease in the IH of the adjacent segment from 11.09 ± 1.82 mm preoperatively to 10.86 ± 1.79 mm at the one-week follow-up after surgery (p < 0.001). The incidence of ASD was 15% (6/40) after an average follow-up period of 79.37 months, with a rate of 15.38% (4/26) in the stenosis or herniated disc group and 14.29% (2/14) in the spondylolisthesis group; however, no statistically significant difference was observed in the occurrence of ASD among these groups (p > 0.05).
The Isobar TTL dynamic fixation system is an effective treatment for LDDs, improving pain relief, quality of life (QoL) and maintaining stabilized segmental motion. It has demonstrated excellent long-term clinical and radiographic results.
Isobar TTL 动态固定系统在治疗腰椎退行性疾病（LDDs）的短期治疗中表现出良好的效果。然而，关于该系统对 LDDs 的长期影响的广泛研究较少。本研究旨在评估接受 Isobar TTL 动态固定系统治疗的 LDDs 患者的长期临床和影像学结果。
研究分析了 2010 年 6 月至 2016 年 12 月在我院接受后路腰椎减压和单节段 Isobar TTL 动态内固定治疗的 40 例 LDDs 患者的结果。临床疗效的评估包括使用视觉模拟评分（VAS）和 Oswestry 残疾指数（ODI）评估术后疼痛水平，分别在术前、术后 3 个月和最终随访时进行。为了确定动态稳定节段的功能运动保持情况，我们在术前和最终随访时测量了稳定节段和相邻节段的活动范围（ROM）和椎间盘高度。此外，我们还研究了相邻节段退变（ASD）的发生情况。
评估了 40 例患者，平均年龄为 44.65 岁，平均随访时间为 79.37 个月。14 例患者属于滑脱组，其余 26 例患者属于狭窄或椎间盘突出组。稳定节段的术前 ROM 从 8.15°±2.77°显著减少到最终随访时的 5.00°±1.82°（p<0.001）。相比之下，相邻节段的 ROM 在最终随访时有轻微升高，从术前的 7.68°±2.25°增加到 9.36°±1.98°（p<0.001）。稳定节段的椎间间隙高度（IH）从术前的 10.56±1.99mm 显著增加到术后 1 周的 11.39±1.90mm（p<0.001）。相反，相邻节段的 IH 从术前的 11.09±1.82mm 显著下降到术后 1 周的 10.86±1.79mm（p<0.001）。平均随访 79.37 个月后，ASD 的发生率为 15%（6/40），其中狭窄或椎间盘突出组为 15.38%（4/26），滑脱组为 14.29%（2/14）；然而，这些组之间 ASD 的发生率无统计学差异（p>0.05）。
Isobar TTL 动态固定系统是治疗 LDDs 的有效方法，可改善疼痛缓解、生活质量（QoL）并维持稳定节段的运动。它具有出色的长期临床和影像学结果。
