Radiological adjacent-segment degeneration in L4-5 spondylolisthesis: comparability between dynamic stabilization and minimally invasive transforaminal lumbar interbody fusion.
J Neurosurg Backbone. 2018 Jun 01;:1-9
Authors: Kuo CH, Huang WC, Wu JC, Tu TH, Fay LY, Wu CL, Cheng H
OBJECTIVE Pedicle screw-based dynamic stabilization has been a substitute for standard lumbar fusion for the surgical administration of low-grade spondylolisthesis. Nevertheless, the true impact of dynamic stabilization on adjacent-segment degeneration (ASD) stays undetermined. Authors of this research aimed to analyze the incidence of ASD and to check the medical outcomes of dynamic stabilization and minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). METHODS The data of consecutive sufferers with Meyerding grade I degenerative spondylolisthesis who had undergone surgical administration at L4-5 within the interval from 2007 to 2014 have been retrospectively reviewed. Sufferers have been divided into two teams based on the surgical procedure carried out: Dynesys dynamic stabilization (DDS) group and MI-TLIF group. Pre- and postoperative radiological evaluations, together with radiography, CT, and MRI research, have been in contrast. Adjoining discs have been evaluated utilizing Four radiological parameters: instability (antero- or retrolisthesis), disc degeneration (Pfirrmann classification), endplate degeneration (Modic classification), and vary of movement (ROM). Scientific outcomes, measured with the visible analog scale (VAS) for again and leg ache, the Oswestry Incapacity Index (ODI), and the Japanese Orthopaedic Affiliation (JOA) scores, have been additionally in contrast. RESULTS A complete of 79 sufferers with L4-5 degenerative spondylolisthesis have been included within the evaluation. Throughout a imply follow-up of 35.2 months (vary 24-89 months), there have been 56 sufferers within the DDS group and 23 within the MI-TLIF group. Previous to surgical procedure, each teams have been very related in demographic, radiological, and medical information. Postoperation, each teams had equally important enchancment in medical outcomes (VAS, ODI, and JOA scores) at every time level of analysis. There was a decrease likelihood of disc degeneration (Pfirrmann classification) of the adjoining discs within the DDS group than within the MI-TLIF group (17% vs 37%, p = zero.01). Nevertheless, the DDS and MI-TLIF teams had related charges of instability (15.2% vs 17.Four%, respectively, p = zero.92) and endplate degeneration (1.eight% vs 6.5%, p = zero.30) on the cranial (L3-Four) and caudal (L5-S1) adjoining ranges after surgical procedure. The imply ROM within the cranial and caudal ranges was additionally related within the two teams. Not one of the sufferers required secondary surgical procedure for any ASD (outlined by radiological standards). CONCLUSIONS The medical enhancements after DDS have been just like these following MI-TLIF for L4-5 Meyerding grade I degenerative spondylolisthesis at three years postoperation. In line with radiological evaluations, there was a decrease likelihood of disc degeneration within the adjoining ranges of the sufferers who had undergone DDS. Nevertheless, different radiological indicators of ASD, together with instability, endplate degeneration, and ROM, have been related between the 2 teams. Though not one of the sufferers within the current sequence required secondary surgical procedure, an extended follow-up and a bigger variety of sufferers could be essential to corroborate the protecting impact of DDS towards ASD.
PMID: 29856306 [PubMed – as supplied by publisher]