Posterior lumbar dynamic stabilization system in the treatment of degenerative lumbar spinal stenosis: efficacy and safety

doi:10.3969/j.issn.2095-4344.0728

Abstract

Abstract:

BACKGROUND: Lumbar posterior dynamic stabilization system is a new nonfusion method for the treatment of lumbar degenerative disease, mainly including interspinous dynamic fixation system and the posterior pedicle fixation device. Wallis system and Dynesys system are representative of two different fixation systems. There is little study on above two fixation systems in the treatment of degenerative lumbar spinal stenosis.

OBJECTIVE: To compare the effectiveness and safety of Wallis system interspinous fixation, Dynesys system transpedicular fixation and fusion in the treatment of degenerative lumbar spinal stenosis.

METHODS: Totally 79 cases of degenerative lumbar spinal stenosis voluntarily receiving the surgery were divided into three groups according to fixation mode. In the fusion group, 30 cases underwent full decompression combined with posterior lumbar interbody fusion. In the Wallis group, 25 cases underwent full decompression combined with interspinous Wallis fixation. In the Dynesys group, 24 cases underwent full decompression combined with pedicle screw fixation with Dynesys system. The follow-up data of all patients were complete at postoperative 3 years.

RESULTS AND CONCLUSION: (1) There was no significant difference in baseline data, intraoperative bleeding and postoperative drainage volume among the three groups (P > 0.05). The operation time of the fusion group was obviously longer than in the other two groups (P < 0.05). (2) There were no significant differences between the Wallis group and the Dynesys group in spinal function scores, visual analogue score of the low back pain, the Oswestry dysfunction index and the imaging measurement indexes (P > 0.05). The spinal function score and Oswestry dysfunction index of the fusion group were significantly decreased at postoperative 3 years (P < 0.01). The spinal function score and Oswestry dysfunction index of the Wallis and Dynesys groups at 1 month after operation were significantly lower than that in the fusion group (P < 0.01). The operation range of the three groups decreased significantly after operation (P < 0.01). Compared with the fusion group, the range of adjacent segments increased significantly in the Wallis group and the Dynesys group; and the intervertebral height, the height of the intervertebral foramen and the area of the intervertebral foramen in the three groups were significantly higher than those before the operation (P < 0.01). (3) There were no significant differences among the three groups in the evaluation of the clinical efficacy and the incidence of complications (P > 0.05). It was shown that lumbar posterior dynamic stabilization system (Wallis and Dynesys systems) internal fixation for degenerative lumbar spinal stenosis can effectively relieve low back pain and maintain lumbar function and activity, and the short-term curative effect is reliable.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Spinal Stenosis, Spinal Fusion, Tissue Engineering

CLC Number:

R318

Deng Yong, Xiang Jing. Posterior lumbar dynamic stabilization system in the treatment of degenerative lumbar spinal stenosis: efficacy and safety [J]. Chinese Journal of Tissue Engineering Research, 2018, 22(15): 2333-2339.

Figures/Tables 1

2.1 参与者数量分析 79例单节段腰椎椎管狭窄的患者均进入结果分析。流程图见图1。 2.2 患者一般资料比较 3组患者性别、年龄、体质量指数、病变节段、病程、术中出血量和术后引流量比较差异均无显著性意义(P > 0.05)，融合术组手术时间较其他两组明显延长(P < 0.05)，见表1。 2.3 各组患者手术前后JOA评分比较 3组患者手术前后JOA评分差异无显著性意义(P > 0.05)；融合组术后3年、Wallis组与Dynesys组患者术后1个月和3年JOA评分较术前均明显提高(P < 0.01)，融合组术后3年较1个月明显提高(P < 0.01)，Wallis组与Dynesys组1个月与3年间无明显差异(P > 0.05)，术后1个月Wallis组与Dynesys组较融合组明显提高(P < 0.01)，见表2。。 2.4 各组患者手术前后腰腿痛目测类比评分和ODI指数比较 3组患者手术前后目测类比和ODI指数比较差异均无显著性意义(P > 0.05)；融合组术后1个月和3年的2项评分较术前均明显降低(P < 0.01)，术后3年ODI指数较术后1个月明显降低(P < 0.01)；Wallis组与Dynesys组术后1个月和3年的2项评分较术前均明显降低(P < 0.01)，1个月与3年间比较差异均无显著性意义(P > 0.05)，见表3。 2.5 各组患者手术前后影像学测量指标比较 3组患者术前手术节段活动范围、手术上下位相邻节段活动范围、手术节段椎间高度、椎间孔高度和椎间孔面积比差异均无显著性意义(P > 0.05)；与术前比较，3组术后手术节段活动范围均明显降低(P < 0.01)，组间比较无显著差异(P > 0.05)；Wallis组与Dynesys组手术上下位相邻节段活动范围较术前与融合组明显升高(P < 0.05)；3组手术节段椎间高度、椎间孔高度和椎间孔面积均较术前明显增高(P < 0.01)，组间比较无显著差异(P > 0.05)，见表4。 2.6 临床疗效比较融合组30例中优21例，良7例，可2例，总优良率93%；Wallis组25例中优19例，良5例，可1例，总优良率96%；Dynesys组24例中优20例，良3例，可1例，总优良率96%；3组总优良率比较差异无显著性意义(χ2=6.545，P=0.073)。 2.7 各组患者术后并发症发生率比较融合组30例中腰痛复发3例，并发症发生率10%；Wallis组25例中固定系统松动/移位1例，腰痛复发1例，发生腰椎后凸畸形1例，并发症发生率12%；Dynesys组24例中腰痛复发1例，间歇性跛行1例，并发症发生率8%。3组患者术后并发症总发生率差异无显著性意义(χ2=0.523，P=0.115)。"

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