Posterior lumbar dynamic stabilization system in the treatment of degenerative lumbar spinal stenosis:efficacy and safety / 中国组织工程研究

ABSTRACT

BACKGROUND: Lumbar posterior dynamic stabilization system is a new nonfusion method for the treatment of lumbar degenerative disease, mainly including interspinous dynamic fixation system and the posterior pedicle fixation device. Wallis system and Dynesys system are representative of two different fixation systems. There is little study on above two fixation systems in the treatment of degenerative lumbar spinal stenosis. OBJECTIVE: To compare the effectiveness and safety of Wallis system interspinous fixation, Dynesys system transpedicular fixation and fusion in the treatment of degenerative lumbar spinal stenosis. METHODS: Totally 79 cases of degenerative lumbar spinal stenosis voluntarily receiving the surgery were divided into three groups according to fixation mode. In the fusion group, 30 cases underwent full decompression combined with posterior lumbar interbody fusion. In the Wallis group, 25 cases underwent full decompression combined with interspinous Wallis fixation. In the Dynesys group, 24 cases underwent full decompression combined with pedicle screw fixation with Dynesys system. The follow-up data of all patients were complete at postoperative 3 years. RESULTS AND CONCLUSION: (1) There was no significant difference in baseline data, intraoperative bleeding and postoperative drainage volume among the three groups (P > 0.05). The operation time of the fusion group was obviously longer than in the other two groups (P <0.05). (2) There were no significant differences between the Wallis group and the Dynesys group in spinal function scores, visual analogue score of the low back pain, the Oswestry dysfunction index and the imaging measurement indexes (P > 0.05). The spinal function score and Oswestry dysfunction index of the fusion group were significantly decreased at postoperative 3 years (P < 0.01). The spinal function score and Oswestry dysfunction index of the Wallis and Dynesys groups at 1 month after operation were significantly lower than that in the fusion group (P < 0.01). The operation range of the three groups decreased significantly after operation (P < 0.01). Compared with the fusion group, the range of adjacent segments increased significantly in the Wallis group and the Dynesys group; and the intervertebral height, the height of the intervertebral foramen and the area of the intervertebral foramen in the three groups were significantly higher than those before the operation (P < 0.01). (3) There were no significant differences among the three groups in the evaluation of the clinical efficacy and the incidence of complications (P > 0.05). It was shown that lumbar posterior dynamic stabilization system (Wallis and Dynesys systems) internal fixation for degenerative lumbar spinal stenosis can effectively relieve low back pain and maintain lumbar function and activity, and the short-term curative effect is reliable.