Lumbar Single-Level Dynamic Stabilization with Semi-Rigid and Full Dynamic Systems: A Retrospective Clinical and Radiological Analysis of 71 Patients

Özer, Ali Fahir; Öktenoğlu, Tunç; Egemen, Emrah; Sasani, Mehdi; Yılmaz, Atilla; Erbulut, Deniz Ufuk; Yaman, Onur; Süzer, Tuncer

doi:10.4055/cios.2017.9.3.310

Cited by 22 publications

(18 citation statements)

References 15 publications

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“…A few of methods like the modified screw and dynamic stabilization system are created to cope with it. However, these attempts still are not able to completely remove the risk of breakage 12 , 37 . Meanwhile, cadaveric research and clinical retrospective study predict the uncertain results because of obvious limitations mainly including nonrepeatability, proof heterogenicity and large consumption.…”

Section: Discussionmentioning

confidence: 99%

“…The previous studies show that screw breakage often occurs around the thread-shank region and has an incidence of 2.6% to 60% 8 – 10 . In recent years, the safety of pedicle screw and connecting rods have been improved by application of new shape, hard material and motorization, but case reports of breakage are not rare 11 , 12 . Protecting pedicle screws and connecting rod from breakage is still needed to be resolved.…”

Section: Introductionmentioning

confidence: 99%

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Stress distribution of different lumbar posterior pedicle screw insertion techniques: a combination study of finite element analysis and biomechanical test

Song

Sun

Zong

et al. 2021

Sci Rep

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At present, the pedicle screw is the most commonly used internal fixation device. However, there are many kinds of common posterior pedicle screw insertion techniques performed to reconstruct the lumbar stability. Therefore, spinal surgeons often face a difficult choice. The stress distribution of internal fixation system is an important index for evaluating safety. Unfortunately, little had been known about the difference of stress distribution of screw-rod systems that established by Roy-Camille, Magerl and Krag insertion techniques. Here, combination of finite element analysis and model measurement research was adopted to evaluate the difference of stress. Following different pedicle screw insertion techniques, three lumbar posterior surgery models were established after modeling and validation of the L1–S1 vertebrae finite element model. By analyzing the data, we found that stress concentration phenomenon was in all the postoperative models. Roy-Camille and Magerl insertion techniques led to the great stress on screw-rod systems. Then, fresh frozen calf spines were selected as a model for subsequent measurements. Fitted with a specially designed test pedicle screw, L5–L6 vertebrae were selected to repeat and verify the results of the finite element analysis. With the aid of universal testing machine and digital torque wrench, models simulated flexion, extension, lateral bending and rotation. Finally, the strain value was captured by the strain gauge and was then calculated as the stress value. Krag and Magerl were found to be the safer choice for pedicle screw insertion. Overall, our combination method obtained the reliable result that Krag insertion technique was the safer approach for pedicle screw implantation due to its relatively dispersive stress. Therefore, without the consideration of screw size, pedicle fill, bone density, and bone structures, we recommend the Krag insertion technique as the first choice to reconstruction of lumbar stability. Additionally, the combination method of finite element analysis and strain gauge measurement can provide a feasible way to study the stress distribution of spinal internal fixation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Stress distribution of different lumbar posterior pedicle screw insertion techniques: a combination study of finite element analysis and biomechanical test

Song

Sun

Zong

et al. 2021

Sci Rep

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“…Several dynamic systems have been described in the literature. [7][8][9] We used a relatively new system based on polyaxial pedicle screws and PEEK rods.…”

Section: Study Impact and Its Implicationsmentioning

confidence: 99%

“…The mean hospital stay in a study using different dynamic stabilization techniques was 3.4 days. 9 Payer et al reported a mean hospital stay of 9 days in patients with dynamic stabilization using the Dynesis Dynamic Stabilization System (Dynesis; Zimmer, Winterthur, Switzerland). 8 In terms of back and leg pain, we found no statistically significant differences between the two groups, and patients in both groups showed good pain reduction at all follow-up examinations.…”

Section: Study Impact and Its Implicationsmentioning

confidence: 99%

Decompression and Dynamic Transpedicular Stabilization Using Polyetheretherketone Rods and Pedicle Screws vs. Decompression Alone for Single-Level Spinal Canal Stenosis with Listhesis: A Retrospective Case-Control Study

Tosic

Baschera

Oberle

et al. 2019

J Neurol Surg A Cent Eur Neurosurg

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Background Spinal stenosis is frequently caused by spondylolisthesis, and surgical treatment may be indicated. However, whether decompression alone or decompression with dynamic stabilization offers better surgical outcomes remains unclear. We compared the clinical and radiologic results of patients with single-level lumbar spinal stenosis and grade 1 spondylolisthesis undergoing microsurgical decompression alone or decompression with transpedicular dorsal dynamic stabilization. Methods We retrospectively analyzed 20 patients undergoing microsurgical decompression and dorsal dynamic transpedicular stabilization using polyetheretherketone (PEEK) rods in one center from 2011 to 2017. Twenty patients with the same diagnosis undergoing microsurgical decompression alone were used as controls. Reoperation of the index and neighboring segments, back/leg pain, neurologic deficits, and the use of pain medication were assessed. For stabilization patients, radiographic progression of degeneration in the neighboring segments, listhesis degree in the index segment, and implant failure were assessed. Results All patients had good clinical outcomes at 3 and 12 months postoperatively. In stabilization patients, the visual analog scale (VAS) score for leg pain decreased from 5 points (median) to 1.6 at 3 months and 0.6 at 1 year postoperatively. In controls, the VAS score improved from 4.8 points to 1.1 at 3 months and 0.3 at 1 year postoperatively. The VAS score for back pain in stabilization patients decreased from 7.6 points (median) to 1.7 at 3 months and 0.1 at 1 year postoperatively. In controls, it decreased from 7.7 points to 1.1 at 3 months and 0.2 at 1 year postoperatively. In patients with additional dynamic stabilization, a longer hospital stay (stabilization group: 8.7 ± 4.1; control: 6.2 ± 1.6 days), longer operative time (stabilization group: 132.7 ± 41.3; control: 83.2 ± 31.7 minutes), and higher complication rates (revision surgery performed in two stabilization patients) were found. Conclusion No indications in our study showed that additional dynamic stabilization with PEEK rods offers any advantage over decompression alone.

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“…The most physiological results were obtained, matching the movement of a motion segment, and single level complication rates were significantly reduced. Patient satisfaction was reasonable [6][7][8][9][10]. However, this system was not suitable for multilevel use even in this form.…”

Section: Introductionmentioning

confidence: 99%

Should Iliac Wing Screws Be Included in Long Segment Dynamic Stabilization?

Özer¹,

Aydın²,

Hekimoğlu

et al. 2021

Cureus

Self Cite

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Background In this article, clinical satisfaction and radiological results are discussed in a series of patients where the iliac wings participate in dynamic stabilization. Dynamic stabilization is an effective alternative surgical treatment method, especially in clinical pictures that go with pain due to minor instabilities. Practically the unique surgical instrument used in multilevel instabilities is the Dynesys system. The most important drawback of the Dynesys system is that the S1 screws become loose in time. In this article, our aim is to find solution to S1 insufficiency by extension of the system to the iliac wings. Methods Nineteen patients (eight females, 11 males) with a mean age of 54.16 were included in the study. Patients had multilevel (level 2 and above) instability, iliac wings were included in the stabilized segments, and Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) were used for patient follow-up. Results First year results showed a significant improvement in VAS and ODI. Regarding the complications, infection developed in one patient, loosening in the proximal iliac wing in one patient, and both S1 and iliac proximals in one patient, but no clinical findings were encountered. Conclusion When more than two levels of dynamic systems are used in chronic instability, especially in the elderly patients, S1 screws are loosened. In these patients, if the iliac bones are also included in stabilization, this problem is solved successfully. However unfortunately, Dynesys system does not have a screw suitable for the iliac bones.

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Lumbar Single-Level Dynamic Stabilization with Semi-Rigid and Full Dynamic Systems: A Retrospective Clinical and Radiological Analysis of 71 Patients

Cited by 22 publications

References 15 publications

Stress distribution of different lumbar posterior pedicle screw insertion techniques: a combination study of finite element analysis and biomechanical test

Stress distribution of different lumbar posterior pedicle screw insertion techniques: a combination study of finite element analysis and biomechanical test

Decompression and Dynamic Transpedicular Stabilization Using Polyetheretherketone Rods and Pedicle Screws vs. Decompression Alone for Single-Level Spinal Canal Stenosis with Listhesis: A Retrospective Case-Control Study

Should Iliac Wing Screws Be Included in Long Segment Dynamic Stabilization?

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