Clinical Experience of the Dynamic Stabilization System for the Degenerative Spine Disease

Lee, Soo-Eon; Park, Sung-Bae; Jahng, Tae-Ahn; Chung, Chun Kee; Kim, Hyun-Jib

doi:10.3340/jkns.2008.43.5.221

Cited by 50 publications

(50 citation statements)

References 17 publications

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“…23 The efficacy of the Dynesys system as a posterior lumbar dynamic stabilization device has been supported by published biomechanical as well as clinical studies. 6,10,12,19 In their anatomical study, Strube et al concluded that increasing the fused levels and stiffness of a fusion system would result in compensatory increase of the range of mobility of the adjacent segment, which might lead to or accelerate the degenerative process in the adjacent segment. They also found that using the Dynesys system adjacent to a singlelevel fusion might prevent hypermobility in the adjacent level.…”

Section: Discussionmentioning

confidence: 99%

“…22 In an attempt to address the problem of adjacent-level disease and degeneration, posterior dynamic stabilization devices have been developed. 2,12,13,15,[19][20][21] Posterior dynamic stabilization, in which pedicle screw fixation is coupled with a flexible longitudinal connecting system, presumably allows for the normalization of intersegmental motion. This stands in contrast to traditional fusion surgery, in which the goal is complete and immediate elimination of motion and, ultimately, arthrodesis.…”

Section: Discussionmentioning

confidence: 99%

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Posterior lumbar dynamic stabilization instead of arthrodesis for symptomatic adjacent-segment degenerative stenosis: description of a novel technique

Mashaly

Paschel

Khattar

et al. 2016

FOC

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OBJECTIVE The development of symptomatic adjacent-segment disease (ASD) is a well-recognized consequence of lumbar fusion surgery. Extension of a fusion to a diseased segment may only lead to subsequent adjacent-segment degeneration. The authors report the use of a novel technique that uses dynamic stabilization instead of arthrodesis for the surgical treatment of symptomatic ASD following a prior lumbar instrumented fusion. METHODS A cohort of 28 consecutive patients was evaluated who developed symptomatic stenosis immediately adjacent to a previous lumbar instrumented fusion. All patients had symptoms of neurogenic claudication refractory to nonsurgical treatment and were surgically treated with decompression and dynamic stabilization instead of extending the fusion construct using a posterior lumbar dynamic stabilization system. Preoperative symptoms, visual analog scale (VAS) pain scores, and perioperative complications were recorded. Clinical outcome was gauged by comparing VAS scores prior to surgery and at the time of last follow-up. RESULTS The mean follow-up duration was 52 months (range 17–94 months). The mean interval from the time of primary fusion surgery to the dynamic stabilization surgery was 40 months (range 10–96 months). The mean patient age was 51 years (range 29–76 years). There were 19 (68%) men and 9 (32%) women. Twenty-three patients (82%) presented with low-back pain at time of surgery, whereas 24 patients (86%) presented with lower-extremity symptoms only. Twenty-four patients (86%) underwent operations that were performed using single-level dynamic stabilization, 3 patients (11%) were treated at 2 levels, and 1 patient underwent 3-level decompression and dynamic stabilization. The most commonly affected and treated level (46%) was L3–4. The mean preoperative VAS pain score was 8, whereas the mean postoperative score was 3. No patient required surgery for symptomatic degeneration rostral to the level of dynamic stabilization during the follow-up period. CONCLUSIONS The use of posterior lumbar dynamic stabilization may offer a valid and safe option for the management of patients who develop ASD rostral to a previously instrumented arthrodesis. The technique may serve as an alternative to multilevel arthrodesis in this patient population. By implanting a dynamic stabilization device instead of an extension of a rigid construct, this might translate into a reduction in the development of yet another level of ASD.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Posterior lumbar dynamic stabilization instead of arthrodesis for symptomatic adjacent-segment degenerative stenosis: description of a novel technique

Mashaly

Paschel

Khattar

et al. 2016

FOC

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“…34,40,41,51,59 Recently, a nonfusion stabilization system with motion preservation (Dynesys system, Zimmer Spine) has been explored as an alternative to fusion in an effort to reduce adjacentsegment disease (ASD) and maintain greater physiological movement and function. 31,32,47,61 Dynesys is a pedicle screw-based dynamic stabilization system that has been used since 1994 and consists of pedicle screws, flexible spacers, and cords. 26,41 This assembly attempts to neutralize the abnormal forces after surgical intervention at the lumbar spine and maintain a more favorable biomechanical environment for segmental motion.…”

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confidence: 99%

Complications associated with the Dynesys dynamic stabilization system: a comprehensive review of the literature

Pham¹,

Mehta²,

Patel

et al. 2016

FOC

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The Dynesys dynamic stabilization system is an alternative to rigid instrumentation and fusion for the treatment of lumbar degenerative disease. Although many outcomes studies have shown good results, currently lacking is a comprehensive report on complications associated with this system, especially in terms of how it compares with reported complication rates of fusion. For the present study, the authors reviewed the literature to find all studies involving the Dynesys dynamic stabilization system that reported complications or adverse events. Twenty-one studies were included for a total of 1166 patients with a mean age of 55.5 years (range 39–71 years) and a mean follow-up period of 33.7 months (range 12.0–81.6 months). Analysis of these studies demonstrated a surgical-site infection rate of 4.3%, pedicle screw loosening rate of 11.7%, pedicle screw fracture rate of 1.6%, and adjacent-segment disease (ASD) rate of 7.0%. Of studies reporting revision surgeries, 11.3% of patients underwent a reoperation. Of patients who developed ASD, 40.6% underwent a reoperation for treatment. The Dynesys dynamic stabilization system appears to have a fairly similar complication-rate profile compared with published literature on lumbar fusion, and is associated with a slightly lower incidence of ASD.

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“…21 Some clinical studies have found positive outcomes with improved Oswestry Disability Index (ODI) and visual analog scale (VAS) pain scores, as well as shorter recovery times, for patients with degenerative lumbar disease treated using the Dynesys system compared with those of patients who underwent fusion. 18,25,27,33,38,39 Although the early outcomes have been promising, the long-term effects are still debated.…”

mentioning

confidence: 99%

“…30 Fusion surgery has been associated with several undesirable effects, such as pseudarthrosis, nonunion, instrumentation failure, and adjacent-segment degeneration (ASD). 18 Even if solid fusion occurs, persistent back pain sometimes haunts surgeons and patients. 30 The Dynesys system (Zimmer, Inc.), a semirigid pediclebased dynamic stabilization (PDS) system, was introduced in an attempt to overcome the drawbacks of fusion procedures.…”

mentioning

confidence: 99%

Dynamic stabilization using the Dynesys system versus posterior lumbar interbody fusion for the treatment of degenerative lumbar spinal disease: a clinical and radiological outcomes-based meta-analysis

Lee

Jahng

Hyun

et al. 2016

FOC

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OBJECTIVE The Dynesys, a pedicle-based dynamic stabilization (PDS) system, was introduced to overcome the drawbacks of fusion procedures. Nevertheless, the theoretical advantages of PDS over fusion have not been clearly confirmed. The aim of this study was to compare clinical and radiological outcomes of patients who underwent PDS using the Dynesys system with those who underwent posterior lumbar interbody fusion (PLIF). METHODS The authors searched PubMed, Embase, Web of Science, and the Cochrane Database. Studies that reported outcomes of patients who underwent PDS or PLIF for the treatment of degenerative lumbar spinal disease were included. The primary efficacy end points were perioperative outcomes. The secondary efficacy end points were changes in the Oswestry Disability Index (ODI) and back and leg pain visual analog scale (VAS) scores and in range of motion (ROM) at the treated and adjacent segments. A meta-analysis was performed to calculate weighted mean differences (WMDs), 95% confidence intervals, Q statistics, and I2 values. Forest plots were constructed for each analysis group. RESULTS Of the 274 retrieved articles, 7 (which involved 506 participants [Dynesys, 250; PLIF, 256]) met the inclusion criteria. The Dynesys group showed a competitive advantage in mean surgery duration (20.73 minutes, 95% CI 8.76–32.70 minutes), blood loss (81.87 ml, 95% CI 45.11–118.63 ml), and length of hospital stay (1.32 days, 95% CI 0.23–2.41 days). Both the Dynesys and PLIF groups experienced improved ODI and VAS scores after 2 years of follow-up. Regarding the ODI and VAS scores, no statistically significant difference was noted according to surgical procedure (ODI: WMD 0.12, 95% CI −3.48 to 3.72; back pain VAS score: WMD −0.15; 95% CI −0.56 to 0.26; leg pain VAS score: WMD −0.07; 95% CI −0.47 to 0.32). The mean ROM at the adjacent segment increased in both groups, and there was no substantial difference between them (WMD 1.13; 95% CI −0.33 to 2.59). Although the United States is the biggest market for Dynesys, no eligible study from the United States was found, and 4 of 8 enrolled studies were performed in China. The results must be interpreted with caution because of publication bias. During Dynesys implantation, surgeons have to decide the length of the spacer and cord pretension. These values are debatable and can vary according to the surgeon's experience and the patient's condition. Differences between the surgical procedures were not considered in this study. CONCLUSIONS Fusion still remains the method of choice for advanced degeneration and gross instability. However, spinal degenerative disease with or without Grade I spondylolisthesis, particularly in patients who require a quicker recovery, will likely constitute the main indication for PDS using the Dynesys system.

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Clinical Experience of the Dynamic Stabilization System for the Degenerative Spine Disease

Cited by 50 publications

References 17 publications

Posterior lumbar dynamic stabilization instead of arthrodesis for symptomatic adjacent-segment degenerative stenosis: description of a novel technique

Posterior lumbar dynamic stabilization instead of arthrodesis for symptomatic adjacent-segment degenerative stenosis: description of a novel technique

Complications associated with the Dynesys dynamic stabilization system: a comprehensive review of the literature

Dynamic stabilization using the Dynesys system versus posterior lumbar interbody fusion for the treatment of degenerative lumbar spinal disease: a clinical and radiological outcomes-based meta-analysis

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