The Efficacy of Lumbar Hybrid Stabilization Using the DIAM™ to Delay Adjacent Segment Degeneration: An Intervention Comparison Study With a Minimum Two-Year Follow-up.
Neurosurgery. 2013 Mar 5;
Authors: Lee CH, Hyun SJ, Kim KJ, Jahng TA, Yoon SH, Kim HJ
BACKGROUND:: Although posterior lumbar interbody fusion (PLIF) has a successful fusion rate, the long-term outcome of PLIF is occasionally below expectations because of adjacent segment degeneration (ASD). OBJECTIVE:: To evaluate the ability of hybrid stabilization using DIAM (Device for Interspinous Assisted Motion) to delay ASD. METHODS:: An intervention comparison study of 75 patients (hybrid, 25; PLIF, 50) was performed. The indications for hybrid stabilization were facet joint degeneration, Pfirrmann grade II-III, and stenosis at the rostral adjacent segment. The PLIF group consisted of patients matched for age, gender, and fusion. The hybrid stabilization procedure included traditional PLIF and DIAM installation at a superior adjacent segment. The outcomes were analyzed using linear mixed model analysis. Conditional logistic regression was performed to calculate the odds ratio for the association of surgical methods. RESULTS:: The hybrid group (24%) revealed fewer ASDs than the PLIF group (48%). Among ASDs, spondylolisthesis occurred more frequently in the PLIF group than the hybrid group. Hybrid surgery was significantly associated with ASD; the odds ratio for hybrid surgery was 0.28 when compared to PLIF. Foraminal height of the PLIF group decreased more than the hybrid group (P=.01). Segmental mobility showed a greater increase in the PLIF group than the hybrid group (P=.04). However, the clinical outcomes did not show significant differences between the groups. CONCLUSION:: Hybrid stabilization using DIAM and pedicle screws can be used for patients with facet degeneration at adjacent segments but should be further investigated.
PMID: 23467248 [PubMed – as supplied by publisher]