Posterior Dynamic Stabilization With Direct Pars Repair via Wiltse Approach for the Treatment of Lumbar Spondylolysis

Rong, Xing; Dou, Qingyu; Li, Xiaolong; Liu, Yin; Kong, Qingquan; Chen, Qi; Gong, Qiyong; Líu, Hao; Song, Yueming

doi:10.1097/brs.0000000000001295

Cited by 13 publications

(18 citation statements)

References 41 publications

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“…In order to avoid the drawbacks associated with fusion and rigid fixation, the Isobar TTL semi-rigid dynamic stabilization system is one of them. The Isobar TTL system was originally designed for fusion surgery to facilitate intervertebral fusion based on Wolff's law and provides spinal stabilization while preserving relatively constant mobility (± 2.25°) of the surgical segment, and the system is currently being used for single-segment non-fusion procedures with good clinical results [ 5 – 7 ]. However, there have been no reports of the Isobar TTL system being used in combine with posterolateral fusion for two-segment hybrid surgery.…”

Section: Introductionmentioning

confidence: 99%

Isobar hybrid dynamic stabilization with posterolateral fusion in mild and moderate lumbar degenerative disease

Guan

Liu

et al. 2023

BMC Musculoskelet Disord

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Objective The aim of this study was to investigate the feasibility of using the Isobar TTL system and posterolateral fusion in a two-segment hybrid fixation approach, combined with spinal decompression, for treating mild and moderate lumbar degenerative disease. Specifically, we sought to evaluate the effectiveness of this approach for managing two-segment mild and moderate lumbar degenerative disease, and to determine whether it could provide a safe and reliable alternative to traditional surgical methods. Methods This retrospective study included 45 consecutive patients with two-level lumbar disc herniation or spinal stenosis, 24 of whom underwent the TTL system and posterolateral fusion combined (TTL group), and 21 of whom underwent posterolateral fusion alone (Rigid group). The surgical segment, admission diagnosis, operation time, and intraoperative bleeding were recorded separately for the two groups of patients. Imaging studies included pre- and postoperative radiography, magnetic resonance imaging, and computed tomography. The clinical outcomes were measured by Oswestry Disability Index (ODI) scores, and a visual analogue scale (VAS) for back and leg pain. Results All patients completed the surgery successfully with a mean follow-up of 56.09 months. The operative time and intraoperative bleeding were lower in the TTL group than in the Rigid group (p < 0.05). All patients showed significant improvements in clinical outcomes, including VAS for back and leg pain, and ODI scores (p < 0.05). ODI scores, the TTL group was better than the Rigid group at 1 year after surgery and at the final follow-up (p < 0.05). Postoperative surgical segment range of motion (ROM) decreased in both groups (p < 0.05). The postoperative ROM of the upper adjacent segment increased in both groups and was significantly higher in both groups at the last follow-up compared with the preoperative period (p < 0.05), and the superior adjacent segment rom of the TTL group was lower than the Rigid group (p < 0.05). The modified Pfrrmann classification of the superior adjacent segment was significantly increased in both groups at the last follow-up (p < 0.05). And in the TTL group, ROM, DH, and modified Pfrrmann grading of dynamic segment outperformed fusion segments. According to the UCLA classification, the incidence of adjacent segment degeneration (ASD) was 4.2% in the TTL group and 23.8% in the Rigid group, and the incidence of ASD was lower in the TTL group than in the Rigid group (P < 0.05). Conclusion The Isobar TTL System was utilized in two-level lumbar hybrid surgery, resulting in no evident indications of lumbar instability being detected on X-rays captured at a minimum of 4 years after the operation, while retaining partial range of motion of the surgical segment. The general clinical efficacy is equivalent to titanium rod fusion surgery, presenting an alternative treatment for individuals with mild and moderate lumbar degenerative disease.

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Section: Introductionmentioning

confidence: 99%

Isobar hybrid dynamic stabilization with posterolateral fusion in mild and moderate lumbar degenerative disease

Guan

Liu

et al. 2023

BMC Musculoskelet Disord

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“…Based on Wolff’s law for fusion surgery, the original design concept of Isobar stabilization system is to promote interbody fusion [ 4 , 5 ]. And some clinicians have also successfully applied the Isobar dynamic stabilization system to non-fusion technology [ 6 – 8 ]. However, how much range of motion should be retained in dynamic stabilization, how to retain it, and which exercise method is more conducive to maintaining the physiological environment of the lumbar spine and slowing the degeneration of the adjacent vertebrae have always been problems that researchers from all over the world have been working to solve.…”

Section: Introductionmentioning

confidence: 99%

Comparison between single-segment Isobar EVO dynamic stabilization and Isobar TTL dynamic stabilization in the treatment of lumbar degenerative diseases: a single center retrospective study over 4 years

Guan

Liu

Feng

et al. 2022

BMC Musculoskelet Disord

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Objective Posterior instrumented fusion is the most widely accepted surgical treatment for spinal stenosis and disc herniation. However, fusion can affect daily activities due to lumbar stiffness. In recent years, dynamic stabilization has been introduced to overcome the drawbacks of fusion, however, it is inconclusive whether dynamic stabilization requires the maintenance of a level of activity that is closer to the physiological state of activity for better clinical efficacy. The purpose of this study was to compare the effectiveness of dynamic stabilization with different levels of activity (Isobar EVO and TTL) in the treatment of spinal stenosis and disc herniation. Methods This study retrospectively reviewed 80 consecutive patients with lumbar degenerative diseases who were undergoing surgical treatment between March 2014 and July 2018. 41 patients (EVO group) and 39 patients (TTL group) underwent fenestrated decompression with Isobar EVO stabilization and Isobar TTL stabilization, respectively. Clinical outcomes, radiographic data, and postoperative complications were compared between the two groups. Results At an average follow-up of 52.23 ± 2.97 months, there were no significant differences in the oswestry disability index (ODI) (P > 0.05). The visual analog scale for back pain (VASback) and visual analog scale for the leg pain (VASleg) of the EVO group were lower compared with the TTL group (P < 0.05). The range of motion (ROM) of operated segments were significantly higher in the EVO group as compared to the TTL group (P < 0.05). The intervertebral space height (ISH) of upper adjacent segments were significantly higher in the EVO group as compared to the TTL group (P < 0.05). The overall complications were less in the EVO group, but the difference was not statistically significant (P > 0.05). Conclusion Both Isobar EVO dynamic stabilization and TTL dynamic stabilization can improve clinical outcomes of patients with spinal stenosis and disc herniation. Isobar EVO has advantages over Isobar TTL in terms of improving low back and leg pain, maintaining mobility of the operated segment, and preventing further degeneration of the upper adjacent segment.

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“…9,22,24 Many studies reported no complications at all associated with surgery. 30,35,36,42,44,53,58 The most commonly reported complications were wound site infection and extended postoperative pain, but even in these studies the incidence of complication represented the vast minority of patients. 22,26,29,37,45 The overall complication rate reported after fusion or other surgical repair includes very few cases of instrumentation failure, recurrent fracture, or pseudoarthrosis.…”

Section: Complication Ratementioning

confidence: 99%

Comparing Surgical Treatments for Spondylolysis

Tarpada

Kim

Levine

et al. 2020

Clinical Spine Surgery: A Spine Publication

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Objective: To compare the various surgical methods of repairing spondylolysis defects in regard to improving pain, restoration of function, radiographic improvement, and complication rate.Summary of Background Data: Spondylolysis is a defect in the pars interarticularis of the vertebral arch, typically in the lumbar vertebra. Treatment can be nonoperative and/or surgical. There are various types of surgical repair including spinal compression, fusion, and direct pars repair.Methods: A comprehensive review of the English literature was performed utilizing Medline, Embase, and Web of Science. Inclusion criteria included papers or abstracts that evaluated the surgical techniques. Exclusion criteria included non-English-language papers or abstracts with inadequate information about outcomes.Results: Postoperative pain levels and patient function were consistently improved, regardless of surgical technique chosen. Positive clinical outcomes after surgery were seen more often in patients under age 20 and those who underwent minimally invasive repairs. Positive radiographic improvements were reported broadly, although some reported higher rates of nonunion with spinal compression. Complication rates were low throughout and minimally invasive techniques reported decreased blood loss and shorter hospital stays.Conclusions: Present surgical options appear largely comparable in terms of their ability to provide meaningful treatment for spondylolysis where conservative treatments have failed or otherwise remain unattempted.

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Posterior Dynamic Stabilization With Direct Pars Repair via Wiltse Approach for the Treatment of Lumbar Spondylolysis

Abstract: 4.

Cited by 13 publications

References 41 publications

Isobar hybrid dynamic stabilization with posterolateral fusion in mild and moderate lumbar degenerative disease

Isobar hybrid dynamic stabilization with posterolateral fusion in mild and moderate lumbar degenerative disease

Comparison between single-segment Isobar EVO dynamic stabilization and Isobar TTL dynamic stabilization in the treatment of lumbar degenerative diseases: a single center retrospective study over 4 years

Comparing Surgical Treatments for Spondylolysis

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