ISObar TTL dynamic fixation system in the treatment of double-segment lumbar disc herniation: 8-year follow-up

doi:10.3969/j.issn.2095-4344.1463

Abstract

Abstract:

BACKGROUND: In patients with double-segment disc herniation complicated with lumbar instability, we need to strengthen and fuse the severely degenerative segments, but the adjacent segments will have excessive movement displacement and flexion and extension angles. The degeneration of adjacent segments will accelerate. The instability of the vertebral body will be aggravated. The hyperplasia of the articular processes and the herniated discs will always plague clinicians and patients.

OBJECTIVE: To observe the efficacy of the ISObar TTL dynamic fixation system versus rigid nail system in the treatment of double-segment lumbar disc herniation and lumbar instability.

METHODS: 130 cases of double-segment lumbar disc herniation and lumbar instability were analyzed, including 72 cases of L_3/4-L_4/5 and 58 cases of L_4/5-L₅/S₁. The laminae decompression and posterior bone graft fusion were performed for severely degenerative segment. For lightly degenerative segments, ISObar TTL dynamic fixation (68 cases; trial group) and traditional nail fixation (62 cases; control group) were performed. Two groups of patients signed the informed consent. This study was approved by the Hospital Ethics Committee. End of death. The patients were followed up for at least 8 years. Disc degeneration was assessed using the modified Pfirrmann eight-level grading system preoperatively, 1 week, 4 years, and 8 years postoperatively. Visual Analogue Scale was utilized to assess the improvement in waist and leg pain.

RESULTS AND CONCLUSION: (1) Compared with preoperatively, waist and leg pain and Visual Analogue Scale scores were significantly improved 1 week, 4 years, and 8 years postoperatively in the trial and control groups (P < 0.05). No significant difference in waist and leg pain and Visual Analogue Scale scores was determined preoperatively and 1 week postoperatively in both groups (P > 0.05). Waist and leg pain and Visual Analogue Scale scores were significantly lower in the trial group than in the control group 4 and 8 years postoperatively (P < 0.05). (2) Compared with preoperatively, no significant difference in the modified Pfirrmann eight-level grading system was detected 1 week, 4 years, and 8 years postoperatively in the fusion segment of the trial and control groups (P > 0.05). There was no significant difference in the modified Pfirrmann eight-level grading system in the fusion segment between the trial and control groups preoperatively, 1 week, 4 years, and 8 years postoperatively (P > 0.05). (3) Compared with preoperatively, the modified Pfirrmann eight-level grading system was significantly improved 1 week, 4 years, and 8 years postoperatively in the trial and control groups (P < 0.05). The modified Pfirrmann eight-level grading system was not significantly different between the trial and control groups preoperatively and 1 week postoperatively (P > 0.05). The modified Pfirrmann eight-level grading system score was significantly lower in the trial group than in the control group 4 and 8 years postoperatively (P < 0.05). (4) The symptoms of double-segment lumbar disc herniation were remarkably improved with ISObar TTL dynamic fixation system and a rigid nail system during 8-year follow-up. However, ISObar TTL dynamic fixation system can relieve waist and leg pain more obviously, and can reduce the degeneration of adjacent intervertebral discs 4 and 8 years postoperatively.

Key words: lumbar spine, intervertebral disc protrusion, lumbar instability, dynamic fixation system, posterolateral bone graft, ISObar TTL connecting rod, strong screw rod fixation, internal fixation

CLC Number:

R459.9|R687.3+2|R318

Cao Zongrui, Zheng Bo, Qu Bo, Jiang Tao, Qu Xiaolong, Chen Tianyi, Zhang Xiuli. ISObar TTL dynamic fixation system in the treatment of double-segment lumbar disc herniation: 8-year follow-up[J]. Chinese Journal of Tissue Engineering Research, 2019, 23(32): 5110-5116.

Figures/Tables 4

References

[1]Qian J, Bao Z, Li X, et al. Short-term therapeutic efficacy of the isobar ttl dynamic internal fixation system for the treatment of lumbar degenerative disc diseases. Pain Physician. 2016;19(6):E853-E861.

[2]Xing R, Dou Q, Li X, et al. Posterior dynamic stabilization with direct pars repair via wiltse approach for the treatment of lumbar spondylolysis: the application of a novel surgery. Spine (Phila Pa 1976).2016;41(8):E494-E502.

[3]Silva P, Rosa RC, Shimano AC, et al. Effect of pilot hole on biomechanical and in vivo pedicle screw-bone interface.Eur Spine J.2013;22(8):1829-1836.

[4]Bronsard N, Serre T, Staccini P, et al.Biometric and biomechanic analysis of lumbar posterior facets based on a CT-scan database. Morphologie.2013;97(316): 19-28.

[5]Mu X, Wei J, A J, et al. The short-term efficacy and safety of artificial total disc replacement for selected patients with lumbar degenerative disc disease compared with anterior lumbar interbody fusion: A systematic review and meta-analysis. PLoS One.2018;13(12):e0209660.

[6]Gao J, Zhao W, Zhang X, et al. MRI analysis of the ISOBAR TTL internal fixation system for the dynamic fixation of intervertebral discs: a comparison with rigid internal fixation. J Orthop Surg Res. 2014;9:43.

[7]Griffith JF, Wang YX, Antonio GE, et al. Modified Pfirrmann grading system for lumbar intervertebral disc degeneration. Spine. 2007;32(24):708-712.

[8]Watanabe K, Matsumoto M, Tsuji T, et al. Ball tip technique for thoracic pedicle screw placement in patients with adolescent idiopathic scoliosis.Neurosurg Spine. 2010;13: 246-252.

[9]冯学烽,章凯,涂强,等.ISOBAR TTL动态固定治疗多节段腰椎退行性病变的早期疗效[J].中国骨科临床与基础研究杂志,2017, 9(5):274-279.

[10]Huang W, Shao G, Li B, et al.Influence of isobar ttl dynamic internal fixation system on adjacent segment degeneration by mri measurement of lumbar nucleus pulposus volume. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi.2016;30(7): 855-860.

[11]Levin JM, Tanenbaum JE, Steinmetz MP, et al. Posterolateral fusion (PLF) versus transforaminal lumbar interbody fusion (TLIF) for spondylolisthesis: a systematic review and meta-analysis.Spine J.2018;18(6):1088-1098.

[12]Hasegewa K, Kitahara K, Hara T, et al. Biomechanical evaluation of segmental instability in degenerative lumbar spondylolisthesis. Eur Spine J. 2009;18(4):465-470.

[13]马亮,许永涛,佘远举.腰椎融合联合上一节段棘突间动态固定的有限元分析[J].中国组织工程研究,2018,22(23):3647-3653.

[14]Ye F, Zeng Z, Wang J, et al. Comparison of the use of rhBMP-7 versus iliac crest autograft in single-level lumbar fusion: a meta-analysis of randomized controlled trials. J Bone Miner Metab.2018;36(1):119-127.

[15]Delawi D, Jacobs W, van Susante JL, et al. OP-1 compared with iliac crest autograft in instrumented posterolateral fusion: a randomized, multicenter non-inferiority trial. J Bone Joint Surg Am.2016;98(6):441-448.

[16]Luo J, Cao K, Yu T, et al. Comparison of posterior lumbar interbody fusion versus posterolateral fusion for the treatment of isthmic spondylolisthesis. Clin Spine Surg. 2017;30(7): E915-E922.

[17]Dang ABC, Hong H, Lee K, et al. Repurposing human osteoarthritic cartilage as a bone graft substitute in an athymic rat posterolateral spinal fusion model. Int J Spine Surg. 2018; 12(6):735-742.

[18]Zhu ZH, Cao P, Liang Y, et al. Experimental study of laparoscopical lumbar interbody fusion with polyporus composite phosphate calcium and rhBMP-2 compounds in sheep. Zhonghua Yi Xue Za Zhi.2010;90(21):1503-1506.

[19]姚欣强,蒋晖,程勇泉,等.Isobar TTL系统治疗腰椎退行性疾病的中长期随访结果[J].中国矫形外科杂志,2017,25(3):199-203.

[20]田一星,包肇华,邹俊,等.单节段Isobar TTL系统动态内固定治疗腰椎退行性疾病的短期效果[J].中国组织工程研究,2018,22(7): 1020-1025.

[21]Qian J, Bao Z, Li X, et al. Short-Term Therapeutic Efficacy of the isobar TTL dynamic internal fixation system for the treatment of lumbar degenerative disc diseases. Pain Physician.2016;19(6):E853-E861.

[22]Chamoli U, Diwan AD, Tsafnat N. Pedicle screw-based posterior dynamic stabilizers for degenerative spine: in vitro biomechanical testing and clinical outcomes.J Biomed Mater Res A.2014;102(9):3324-3340.

[23]Li Z, Li F, Yu S, et al. Two-year follow-up results of the Isobar TTL Semi-Rigid Rod System for the treatment of lumbar degenerative disease.J Clin Neurosci. 2013;20(3):394-399.

[24]史舅生,张国平,方文,等.单侧与双侧椎弓根钉内固定椎体间融合术治疗腰椎退行性疾病的比较[J].中国骨与关节损伤杂志, 2018, 33(3):292-294.

[25]Yu AK, Siegfried CM, Chew B, et al. Biomechanics of posterior dynamic fusion systems in the lumbar spine: implications for stabilization with improved arthrodesis. Clin Spine Surg. 2016,29(7):E325-E330.

[26]Han YC, Liu ZQ, Wang SJ, et al. Comparison of unilateral versus bilateral pedicle screw fixation in degenerative lumbar diseases：a meta-analysis. Eur Spine J. 2014;23(5):974-984.

[27]吕建华,唐昭惠,陈凯,等.半坚强与坚强内固定邻近节段腰椎间盘角位移及应力的比较[J].中国组织工程研究,2016,20(9):1275-1281.

[28]Khechen B, Haws BE, Patel DV, et al. Comparison of postoperative outcomes between primary MIS TLIF and MIS TLIF with revision decompression. Spine (Phila Pa 1976). 2019,44(2):150-156.