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Change of Lumbar Motion after Multi-Level Posterior Dynamic Stabilization with Bioflex System : 1 Year Follow Up

  • Park, Hun-Ho (Department of Neurosurgery, National Health Insurance Corporation Ilsan Hospital, Goyang, Yonsei University College of Medicine) ;
  • Zhang, Ho-Yeol (Department of Neurosurgery, National Health Insurance Corporation Ilsan Hospital, Goyang, Yonsei University College of Medicine) ;
  • Cho, Bo-Young (Department of Neurosurgery, National Health Insurance Corporation Ilsan Hospital, Goyang, Yonsei University College of Medicine) ;
  • Park, Jeong-Yoon (Department of Neurosurgery, National Health Insurance Corporation Ilsan Hospital, Goyang, Yonsei University College of Medicine)
  • Published : 2009.10.28

Abstract

Objective : This study examined the change of range of motion (ROM) at the segments within the dynamic posterior stabilization, segments above and below the system, the clinical course and analyzed the factors influencing them. Methods : This study included a consecutive 27 patients who underwent one-level to three-level dynamic stabilization with Bioflex system at our institute. All of these patients with degenerative disc disease underwent decompressive laminectomy with/without discectomy and dynamic stabilization with Bioflex system at the laminectomy level without fusion. Visual analogue scale (VAS) scores for back and leg pain, whole lumbar lordosis (from L1 to S1), ROMs from preoperative, immediate postoperative, 1.5, 3, 6, 12 months at whole lumbar (from L1 to S1), each instrumented levels, and one segment above and below this instrumentation were evaluated. Results : VAS scores for leg and back pain decreased significantly throughout the whole study period. Whole lumbar lordosis remained within preoperative range, ROM of whole lumbar and instrumented levels showed a significant decrease. ROM of one level upper and lower to the instrumentation increased, but statistically invalid. There were also 5 cases of complications related with the fixation system. Conclusion : Bioflex posterior dynamic stabilization system supports operation-induced unstable, destroyed segments and assists in physiological motion and stabilization at the instrumented level, decrease back and leg pain, maintain preoperative lumbar lordotic angle and reduce ROM of whole lumbar and instrumented segments. Prevention of adjacent segment degeneration and complication rates are something to be reconsidered through longer follow up period.

Keywords

References

  1. Ahn YH, Chen WM, Lee KY, Park KW, Lee SJ : Comparison of the load-sharing characteristics between pedicle-based dynamic and rigid rod devices. Biomed Mater 3 : 44101, 2008 https://doi.org/10.1088/1748-6041/3/4/044101
  2. Bellini CM, Galbusera F, Raimondi MT, Mineo GV, Brayda-Bruno M : Biomechanics of the lumbar spine after dynamic stabilization. J Spinal Disord Tech 20 : 423-429, 2007 https://doi.org/10.1097/BSD.0b013e318031af6f
  3. Gibson JN, Grant IC, Waddell G : The Cochrane review of surgery for lumbar disc prolapse and degenerative lumbar spondylosis. Spine (Phila Pa 1976) 24 : 1820-1832, 1999 https://doi.org/10.1097/00007632-199909010-00012
  4. Highsmith JM, Tumialan LM, Rodts GE Jr : Flexible rods and the case for dynamic stabilization. Neurosurg Focus 22 : E11, 2007
  5. Khoueir P, Kim KA, Wang MY : Classification of posterior dynamic stabilization devices. Neurosurg Focus 22 : E3, 2007
  6. Kim YS, Zhang HY, Moon BJ, Park KW, Ji KY, Lee WC, et al. : Nitinol spring rod dynamic stabilization system and Nitinol memory loops in surgical treatment for lumbar disc disorders: short-term follow up. Neurosurg Focus 22 : E10, 2007
  7. Kumar A, Beastall J, Hughes J, Karadimas EJ, Nicol M, Smith F, et al. : Disc changes in the bridged and adjacent segments after Dynesys dynamic stabilization system after two years. Spine (Phila Pa 1976) 33 : 2909-2914, 2008 https://doi.org/10.1097/BRS.0b013e31818bdca7
  8. La Grone MO : Loss of lumbar lordosis. A complication of spinal fusion for scoliosis. Orthop Clin North Am 19 : 383-393, 1988
  9. Lagrone MO, Bradford DS, Moe JH, Lonstein JE, Winter RB, Ogilvie JW : Treatment of symptomatic flatback after spinal fusion. J Bone Joint Surg Am 70 : 569-580, 1988
  10. Ledet EH, Carl AL, DiRisio DJ, Tymeson MP, Andersen LB, Sheehan CE, et al. : A pilot study to evaluate the effectiveness of small intestinal submucosa used to repair spinal ligaments in the goat. Spine J 2 : 188-196, 2002 https://doi.org/10.1016/S1529-9430(02)00182-1
  11. Markwalder TM, Wenger M : Dynamic stabilization of lumbar motion segments by use of Graf ’s ligaments : results with an average follow-up of 7.4 years in 39 highly selected, consecutive patients. Acta Neurochir (Wien) 145 : 209-214; discussion 214, 2003 https://doi.org/10.1007/s00701-002-1056-9
  12. McAfee PC : Interbody fusion cages in reconstructive operations on the spine. J Bone Joint Surg Am 81 : 859-880, 1999
  13. Rigby MC, Selmon GP, Foy MA, Fogg AJ : Graf ligament stabilisation : mid- to long-term follow-up. Eur Spine J 10 : 234-236, 2001 https://doi.org/10.1007/s005860100254
  14. Rohlmann A, Burra NK, Zander T, Bergmann G : Comparison of the effects of bilateral posterior dynamic and rigid fixation devices on the loads in the lumbar spine : a finite element analysis. Eur Spine J 16 : 1223-1231, 2007 https://doi.org/10.1007/s00586-006-0292-8
  15. Schaeren S, Broger I, Jeanneret B : Minimum four-year follow-up of spinal stenosis with degenerative spondylolisthesis treated with decompression and dynamic stabilization. Spine (Phila Pa 1976) 33 : E636- E642, 2008 https://doi.org/10.1097/BRS.0b013e31817d2435
  16. Sengupta DK : Dynamic stabilization devices in the treatment of low back pain. Neurol India 53 : 466-474, 2005 https://doi.org/10.4103/0028-3886.22614
  17. Sengupta DK, Mulholland RC : Fulcrum assisted soft stabilization system : a new concept in the surgical treatment of degenerative low back pain. Spine (Phila Pa 1976) 30 : 1019-1029; discussion 1030, 2005 https://doi.org/10.1097/01.brs.0000160986.39171.4d

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  2. Effects of nonlinearity in the materials used for the semi-rigid pedicle screw systems on biomechanical behaviors of the lumbar spine after surgery vol.6, pp.5, 2009, https://doi.org/10.1088/1748-6041/6/5/055005
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