Letter to the Editor: Pedicle screw–based dynamic stabilization and adjacent-segment disease

Cheng, Yu Wen; Chang, Po-Ya; Wu, Jau Ching; Chang, Chia Chin; Fay, Li Yu; Tu, Tsung Hsi; Huang, Wen Cheng; Cheng, Henrich

doi:10.3171/2016.7.spine16816

Cited by 4 publications

(2 citation statements)

References 16 publications

(6 reference statements)

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“…Furthermore, patients with immobile segmental motion (< 3°) on lateral dynamic radiographs would have been recommended for fusion procedures rather than DDS. Surprisingly, in our series of DDS, 4,6,[12][13][14]28,29 a substantial portion of the patients who underwent dynamic stabilization ended up with little segmental mobility and were found to have the facets fused. Therefore, the present study was designed to demonstrate that spondylolisthesis could be a risk factor of the limited segmental mobility found after DDS, although DDS was originally designed for preservation of motion and avoidance of fusion.…”

Section: Discussionmentioning

confidence: 57%

Unintended facet fusions after Dynesys dynamic stabilization in patients with spondylolisthesis

Fay

Huang

Chang

et al. 2019

Journal of Neurosurgery: Spine

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OBJECTIVEThe pedicle screw–based Dynesys dynamic stabilization (DDS) has reportedly become a surgical option for lumbar spondylosis and spondylolisthesis. However, it is still unclear whether the dynamic construct remains mobile or eventually fuses. The aim of this study was to investigate the incidence of unintended facet arthrodesis after DDS and its association with spondylolisthesis.METHODSThis retrospective study was designed to review 105 consecutive patients with 1- or 2-level lumbar spondylosis who were treated with DDS surgery. The patients were then divided into 2 groups according to preexisting spondylolisthesis or not. All patients underwent laminectomies, foraminotomies, and DDS. The clinical outcomes were measured using visual analog scale (VAS) scores for back and leg pain, Japanese Orthopaedic Association (JOA) scores, and Oswestry Disability Index (ODI) scores. All medical records, including pre- and postoperative radiographs, CT scans, and MR images, were also reviewed and compared.RESULTSA total of 96 patients who completed the postoperative follow-up for more than 30 months were analyzed. The mean age was 64.1 ± 12.9 years, and the mean follow-up duration was 46.3 ± 12.0 months. There were 45 patients in the spondylolisthesis group and 51 patients in the nonspondylolisthesis group. The overall prevalence rate of unintended facet fusion was 52.1% in the series of DDS. Patients with spondylolisthesis were older (67.8 vs 60.8 years, p = 0.007) and had a higher incidence rate of facet arthrodesis (75.6% vs 31.4%, p < 0.001) than patients without spondylolisthesis. Patients who had spondylolisthesis or were older than 65 years were more likely to have facet arthrodesis (OR 6.76 and 4.82, respectively). There were no significant differences in clinical outcomes, including VAS back and leg pain, ODI, and JOA scores between the 2 groups. Furthermore, regardless of whether or not unintended facet arthrodesis occurred, all patients experienced significant improvement (all p < 0.05) in the clinical evaluations.CONCLUSIONSDuring the mean follow-up of almost 4 years, the prevalence of unintended facet arthrodesis was 52.1% in patients who underwent DDS. Although the clinical outcomes were not affected, elderly patients with spondylolisthesis might have a greater chance of facet fusion. This could be a cause of the limited range of motion at the index levels long after DDS.

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Section: Discussionmentioning

confidence: 57%

Unintended facet fusions after Dynesys dynamic stabilization in patients with spondylolisthesis

Fay

Huang

Chang

et al. 2019

Journal of Neurosurgery: Spine

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“…32,36 Percutaneous fusion techniques or use of the Wiltse approach may lower the risk of adjacent segment disease due to avoidance of facet capsule disruption. 37,38 Dynamic stabilization techniques do not appear be clearly protective against adjacent segment disease, although biomechanical models suggest that they may do so. 33,39,40 A review by Wang and colleagues pooled studies to assess the risk of lumbar adjacent segment disease in spinal fusion to compare to disc arthroplasty and concluded that fusion carried a higher risk of adjacent segment disease.…”

Section: Adjacent Segment Diseasementioning

confidence: 99%

Lumbar Fusion With Polyetheretherketone Rods Use for Patients With Degenerative Disease

Ross¹,

Ross²

2021

Federal Practitioner

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Polyetheretherketone (PEEK) rods for lumbar fusion have been available since 2007. However, literature about their utility is sparse and of mixed outcomes. Methods: A retrospective review of PEEK rod lumbar fusion cases was performed. Data were analyzed from 108 patients of the senior author Donald Ross who underwent PEEK lumbar fusion. Results: There were 97 single and 11 2-level fusions. Rates of tobacco use, diabetes mellitus, low bone density, depression, and immunosuppression were 23.1%, 24.1%, 14.8%, 32.4%, and 6.5%, respectively. In the study population, the mean age was 60.2 years, body mass index was 30.1, and there was a mean 31.3 months for follow-up. There were no wound infections or new neurologic deficits. Of 81 patients with > 11 months of follow-up, 70 (86.4%) had an arthrodesis, 8 (9.9%) had no ar-throdesis, and 3 (3.7%) were indeterminate. No patients had revision fusion surgery and 2 patients had adjacent level fusions at 27 and 60 months. One patient had an adjacent segment laminectomy at 18 months and one a foraminotomy at 89 months, resulting in a 3.7% adjacent segment surgery rate. Mean preoperative Short Form-36 (SF-36) physical functioning (PF) score and Oswestry Disability Index (ODI) score were 28.9 and 24.8, respectively. Mean SF-36 PF postoperative score at 1 and 2 years were 59.3 and 65, respectively. Mean ODI postoperative score at 1 year was 14.5. Conclusions:In a large patient cohort lumbar fusion with PEEK rods can be undertaken with low complication rates, satisfactory clinical improvements, low rates of hardware failure or need for revision surgery. Longer follow-up is needed to confirm findings.

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Commentary: Low-Grade Infection and Implant Failure Following Spinal Instrumentation: A Prospective Comparative Study

Chang

Huang

2020

Neurosurg.

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Letter to the Editor: Pedicle screw–based dynamic stabilization and adjacent-segment disease

Cited by 4 publications

References 16 publications

Unintended facet fusions after Dynesys dynamic stabilization in patients with spondylolisthesis

Unintended facet fusions after Dynesys dynamic stabilization in patients with spondylolisthesis

Lumbar Fusion With Polyetheretherketone Rods Use for Patients With Degenerative Disease

Commentary: Low-Grade Infection and Implant Failure Following Spinal Instrumentation: A Prospective Comparative Study

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