Biomechanics and clinical effect of lumbar transpedicular dynamic fixation systems / 中华骨科杂志

ABSTRACT

Lumbar degenerative disease is one of the most common diseases in orthopaedic clinics, and the chronic low back pain caused by it seriously affects patients' living quality. Currently, intervertebral fusion and rigid fixation are the main surgical methods for lumbar degenerative disease. Although the intervertebral fusion and rigid fixation can achieve a higher fusion rate, due to the stress concentration of adjacent segments, the adjacent segment degeneration may occur and make the patient's satisfaction rate much lower than the imaging fusion rate. Dynamic fixation is a new fixing concept, which can control the abnormal motion of the spine segment while retaining part of the movement of the fixed segment. Moreover, dynamic fixation is also beneficial to reduce the degeneration of adjacent segments and the incidence of breakage of internal fixation. Nowadays, various lumbar transpedicular dynamic fixation systems have appeared on the market. Most of these transpedicular dynamic fixation systems are derived from the design of pedicle screws and rods used in spinal fusion surgery in the 1980 s and 1990 s. The original intention of their design is to stabilize the abnormal segments and reduce the pressure on degenerated intervertebral discs and facet joints, while maintaining the normal movement of relevant segments. By reviewing the biomechanical research, clinical efficacy, existing problems and advantages and disadvantages of common backward lumbar transpedicular dynamic fixation systems, this article intends to provide new ideas for the improvement of the backward lumbar transpedicular dynamic fixation system design, as well as offering surgical treatment strategies for clinicians.