Comparison of Posterior Dynamic and Posterior Rigid Transpedicular Stabilization With Fusion to Treat Degenerative Spondylolisthesis

Abstract

This article describes the clinical and radiological outcomes of a comparison of posterior dynamic transpedicular stabilization and posterior rigid transpedicular stabilization with fusion after decompression in the treatment of degenerative spondylolisthesis. This prospective clinical and radiologic study was conducted between 2004 and 2007 and included 46 patients, of whom 33 were women (71.7%) and 13 were men (28.3%). Mean patient age was 61.67+/-10.80 years (range, 45-89 years). Twenty-six patients who underwent lumbar decompression and posterior dynamic transpedicular stabilization were followed for a mean of 38 months (range, 24-55 months). In the fusion group, 20 patients who underwent lumbar decompression and rigid stabilization with fusion were followed for a mean of 44 months (range, 26-64 months). The intervertebral space measurements of the dynamic group at the preoperative examination and at 12 and 24 months postoperatively were statistically significantly higher than the intervertebral space measurements of the fusion group (P<.05). In the dynamic group, complications occurred in 2 patients; the first was a screw malposition, which was improved with revision surgery within 1 month of the initial surgery, and the second was a fusion performed in the second year in 1 patient because the patient reported continued pain. In the fusion group, adjacent segment disease was observed in 1 patient, with subsequent reoperation. Lumbar decompression and posterior dynamic transpedicular stabilization yield satisfactory results in the treatment of degenerative lumbar spondylolisthesis and can be considered a valid alternative to fusion.

Can posterior dynamic stabilization reduce the risk of adjacent segment deterioration?

“…inclusion criteria (2,3,6,(11)(12)(13)(14)(15)(16)(17)(19)(20)(21)(22)(23)(26)(27)(28)(29)(30)33,34,36,37,(41)(42)(43)(45)(46)(47) (Figure 1). For the possible duplicate studies (31&40,14&23,13&15), only the data from the trial with the longest follow-up were used for estimating the incidence of ASD.…”

“…Among the 23 articles with the PDS procedure only, twelve reported the incidence of ASDeg (Table I), and thirteen reported that of ASDis (Table II), with two articles investigating both rates. Four investigations compared the incidence of ASDeg/ASDis between the PDS and fusion procedures (13,16,17,29).…”

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

“…Seven studies in this analysis included patients with spondylolisthesis (Grade I). Although the rates of spondylolisthesis were 49% and 100% in the reports by Kaner et al 13 and Yu et al, 39 the Dynesys groups in these studies had similar clinical and radiological outcomes that were not inferior to those of the PLIF groups. Previous reports also found that Dynesys provides similar radiographic stability and clinical effects regardless of preoperative spondylolisthesis.…”

“…9,38 Among the 7 studies, Kaner et al 13 included patients with Grade I or II spondylolisthesis, and the others included patients with only Grade I spondylolisthesis.…”

“…The patients of 5 studies underwent single-level PLIF or PDS. 4,13,36,37,39 Two studies were concerned with surgery on 3 or fewer segments.…”