Short-term effectiveness of single-level Isobar TTL dynamic internal fixation in the treatment of lumbar degenerative diseases

doi:10.3969/j.issn.2095-4344.0052

Abstract

Abstract:

BACKGROUND: The short-term effects of dynamic internal fixation and whether dynamic internal fixation system can prevent or delay the process of adjacent level degeneration after lumbar surgery remain in controversy.

OBJECTIVE: To investigate the short-term clinical effectiveness of single-level Isobar TTL dynamic internal fixation in the treatment of degenerative lumbar diseases.

METHODS: Data of 20 patients who suffered from lumbar degenerative diseases and underwent posterior decompression combined with single-level Isobar TTL dynamic internal fixation, including 11 male patients and 9 female patients, were retrospectively analyzed; the average age of these patients was 47.4 (35-62) years old. Visual analog scale, Japanese Orthopaedic Association scores and Oswestry disability index were used to assess clinical outcomes. Disc height, range of motion, and University of California at Los Angeles Grading Scale were measured on X-ray films to evaluate the status of disc degeneration on both dynamic fixed segment (index segment) and superior adjacent segment.

RESULTS AND CONCLUSION: All follow-up patients successfully completed the operation. The average follow-up time was 14.4 (12-27) months. No blood vessels, nerve injury, loose internal fixation or rupture occurred. At the last follow-up, Visual Analog Scale, Japanese Orthopaedic Association scores and Oswestry Disability Index were significantly improved (P < 0.05); range of motion of dynamic fixation segment reduced (P < 0.05) as compared with that before surgery. Intervertebral height of dynamic fixation segments and University of California at Los Angeles Grading Scale classification were not significantly different between follow-up and before surgery (P > 0.05). Intervertebral height of superior adjacent segment, intervertebral range of motion and University of California at Los Angeles Grading Scale classification were not significantly different (P > 0.05). These results indicate that single-level Isobar TTL dynamic internal fixation proved to have satisfactory clinical outcomes in the treatment of lumbar degenerative diseases. During follow-up, disc degeneration on either index segment or superior adjacent segment is not accelerated.

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: Internal Fixators, Intervertebral Disk Degeneration, Spinal Fusion

CLC Number:

R318

Tian Yi-xing, Bao Zhao-hua, Zou Jun, Ji Yi-ming, Mei Xin, Pan Jun, He Wen-ye, Yang Hui-lin. Short-term effectiveness of single-level Isobar TTL dynamic internal fixation in the treatment of lumbar degenerative diseases [J]. Chinese Journal of Tissue Engineering Research, 2018, 22(7): 1020-1025.

Figures/Tables 4

References

[1] Donnally IC, Dulebohn SC. Lumbar degenerative disk disease, in StatPearls. 2017: Treasure Island (FL).

[2] Sangiorgio SN, Sheikh H, Borkowski SL, et al. Comparison of three posterior dynamic stabilization devices. Spine. 2011; 36(19):E1251-1258.

[3] Madan SS, Boeree NR. Comparison of instrumented anterior interbody fusion with instrumented circumferential lumbar fusion. Eur Spine J. 2003;12(6):567-575.

[4] Yu SW, Yen CY, Wu CH, et al. Radiographic and clinical results of posterior dynamic stabilization for the treatment of multisegment degenerative disc disease with a minimum follow-up of 3 years. Arch Orthop Trauma Surg. 2012;132(5): 583-589.

[5] Zhou ZJ, Xia P, Zhao X, et al. Can posterior dynamic stabilization reduce the risk of adjacent segment deterioration? Turk Neurosurg. 2013;23(5):579-589.

[6] Kaner T, Ozer AF. Dynamic stabilization for challenging lumbar degenerative diseases of the spine: a review of the literature. Adv Orthop. 2013;2013:753470.

[7] Prud'homme M, Barrios C, Rouch P, et al. Clinical outcomes and complications after pedicle-anchored dynamic or hybrid lumbar spine stabilization: a systematic literature review. J Spinal Disord Tech. 2015;28(8):E439-448.

[8] Sengupta DK, Herkowitz HN. Pedicle screw-based posterior dynamic stabilization: literature review. Adv Orthop. 2012; 2012:424268.

[9] Bono CM, Kadaba M, Vaccaro AR. Posterior pedicle fixation-based dynamic stabilization devices for the treatment of degenerative diseases of the lumbar spine. J Spinal Disord Tech. 2009;22(5):376-383.

[10] 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.

[11] Qian J, Bao ZH, 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):E853-861.

[12] Wang Y, Fu W, Zhang S, et al. CXCR-7 receptor promotes SDF-1α-induced migration of bone marrow mesenchymal stem cells in the transient cerebral ischemia/reperfusion rat hippocampus. Brain Res. 2014;1575:78-86.

[13] Hudson WR, Gee JE, Billys JB, et al. Hybrid dynamic stabilization with posterior spinal fusion in the lumbar spine. SAS J. 2011;5(2):36-43.

[14] 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.

[15] 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.

[16] 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. 2016;41(8):E494-502.

[17] Yang JY, Lee JK, Song HS. The impact of adjacent segment degeneration on the clinical outcome after lumbar spinal fusion. Spine (Phila Pa 1976). 2008;33(5):503-507.

[18] Dahl B, Gehrchen P, Blyme P, et al. Clinical outcome after spinal fusion with a rigid versus a semi-rigid pedicle screw system. Eur Spine J. 1997;6(6):412-416.

[19] Zencica P, Chaloupka R, Hladikova J, et al. Adjacent segment degeneration after lumbosacral fusion in spondylolisthesis: a retrospective radiological and clinical analysis. Acta Chir Orthop Traumatol Cech. 2010;77(2):124-130.

[20] Kalanithi PS, Patil CG, Boakye M. National complication rates and disposition after posterior lumbar fusion for acquired spondylolisthesis. Spine. 2009;34(18):1963-1969.

[21] Xia XP, Chen HL, Cheng HB. Prevalence of adjacent segment degeneration after spine surgery: a systematic review and meta-analysis. Spine. 2013;38(7):597-608.

[22] Kumar MN, Baklanov A, Chopin D. Correlation between sagittal plane changes and adjacent segment degeneration following lumbar spine fusion. Eur Spine J. 2001;10(4): 314-319.

[23] Morishita Y, Ohta H, Naito M, et al. Kinematic evaluation of the adjacent segments after lumbar instrumented surgery: a comparison between rigid fusion and dynamic non-fusion stabilization. Eur Spine J. 2011;20(9):1480-1485.

[24] Chuang WH, Lin SC, Chen SH, et al. Biomechanical effects of disc degeneration and hybrid fixation on the transition and adjacent lumbar segments: trade-off between junctional problem, motion preservation, and load protection. Spine. 2012;37(24):E1488-1497.

[25] 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.

[26] Cakir B, Carazzo C, Schmidt R, et al. Adjacent segment mobility after rigid and semirigid instrumentation of the lumbar spine. Spine. 2009;34(12):1287-1291.

[27] Zhang L, Shu X, Duan Y, et al. Effectiveness of ISOBAR TTL semi-rigid dynamic stabilization system in treatment of lumbar degenerative disease. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2012;26(9):1066-1070.

[28] 饶敏杰,钟招明,曾纪焕,等.Isobar TTL内固定系统治疗腰椎退行性疾病的临床疗效[J].中国骨与关节损伤杂志, 2013,28(3): 222-224.

[29] Zhang ZM, Jin DD, Chen JT. Comparative study of dynamic fixation with rigid fixation in the management of degenerative lumbar spondylosis. Zhonghua Wai Ke Za Zhi. 2008;46(5): 346-349.

[30] 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.

[31] Fu L, France A, Xie Y, et al. Functional and radiological outcomes of semi-rigid dynamic lumbar stabilization adjacent to single-level fusion after 2 years. Arch Orthop Trauma Surg. 2014;134(5):605-610.