Saratov JOURNAL of Medical and Scientific Research

Evaluation of the efficiency of simultaneous rigid fixing and interspinous stabilization in patients with degenerative diseases of the lumbar spine


Purpose: to assess the effectiveness of simultaneous rigid fixation and interspinous stabilization in patients with degenerative diseases of the lumbar spine. Material and Methods. The study included 216 patients with degenerative diseases of the lumbar spine, who in 109 cases underwent isolated rigid fixation, and in 107 cases, additional simultaneous interspecific stabilization. Results. When compared with the group of isolated rigid fixation, when conducting an additional simultaneous interspinous stabilization of the adjacent segment, lower indices of the level of pain syndrome and better functional status were noted. The total number of postoperative complications in the first group is 17.4%, in the second 5.6% (p=0.02). According to the instrumental data, a statistically significantly lower degeneration of the adjacent segment in group II (p<0.001) was noted, while in 11 group I patients additional decompression-stabilizing interventions at the adjacent level were performed. Conclusion. Simultaneous rigid fixation with the installation of an interspinous stabilizer at an adjacent level in the treatment of patients with degenerative diseases of the lumbar spine can significantly reduce the level of pain, improve functional status and also protect the adjacent segment from the progression of the degenerative process in it and reduce the number of repeated surgical interventions.

1. Aleksanyan MM, Aganesov AG. Surgical treatment of degenerative stenosis of the lumbar spine using dynamic implants. Spinal surgery. 2016; 13 (2): 52-61.
2. Byvaltsev VA, Kalinin АА. Possibilities for the use of minimally invasive dorsal decompressive-stabilizing interventions in patients with overweight and obesity. Questions of neurosurgery n. a. N.N. Burdenko 2018; 5: 69-80.
3. Lee SH, Seol A, Cho TY, et al. A Systematic Review of Interspinous Dynamic Stabilization. Clin Orthop Surg 2015; 7 (3): 323-9. DOI: 10.4055/cios. 2015.7.3.323.
4. Sakaura H, Yamashita T, Miwa T, et al. Symptomatic adjacent segment pathology after posterior lumbar interbody fusion for adult low-grade isthmic spondylolisthesis. Global Spine J 2013; 3 (4): 219-24. DOI: 10.1055/S-0033-1348088.
5. Byvaltsev VA, Kalinin AA. The use of minimally invasive methods of rigid stabilization of the lumbar spine among the employees of Russian Railways. Occupational medicine and industrial ecology 2018; 1: 39-43.
6. Butler D, Trafimow JH, Andersson GB, et al. Discs degenerate before facets. Spine 1990; 15 (2): 111-3.
7. Kuchta J, Sobottke R, Eysel P, Simons P. Two-year results of interspinous spacer (X-STOP) implantation of 175 patients with neurologic intermittent claudication due to lumbar spinal stenosis. Eur Spine J 2009; 18 (6): 823-9. DOI: 10.1007/s00586-009-0967-z.
8. Lawrence BD, Wang J, Arnold PM, et al. Predicting the risk of adjacent segment pathology after lumbar fusion: a systematic review. Spine 2012; 37 (22): S123-S132. DOI: 10.1097/BRS. 0b013e31826d60d8.
9. Szpalski M, Gunzburg R, Mayer M. Spine arthroplasty: a historical review. Eur Spine J 2002; 11 (2): S65-S84.
10. Byvaltsev VA, Kalinin AA, Okoneshnikova AK, et al. Facet fixation in combination with interbody spinal fusion: a comparative analysis and clinical experience of a new method of surgical treatment of patients with degenerative diseases of the lumbar spine. Bulletin of the Russian Academy of Medical Sciences 2016; 71 (5): 375-83.
11. Bowers С, Amini A, Dailey AT, Schmidt MH. Dynamic interspinous process stabilization: Review of complications associated with the X-STOP device. Neurosurg Focus 2010; 28 (6): E8. DOI: 10.3171/2010.3. FOCUS1047.
12. Kaner T, Sasani M, Oktenoglu T, Ozer AF. Dynamic stabilization of the spine: a new classification system. Turk Neurosurg 2010; 20 (2): 205-215. DOI: 10.5137/1019-5149. JTN. 2358-09.2.
13. Davis RJ, Errico TJ, Bae H, Auerbach JD. Decompression and Coflex interlaminar stabilization compared with decompression and instrumented spinal fusion for spinal stenosis and low-grade degenerative spondylolisthesis: two-year results from the prospective, randomized, multicenter, food and drug administration investigational device exemption trial. Spine 2013; 38 (18): 1529-39. DOI: 10.1097/BRS. 0b013e31829a6d0a.
14. Roussouly P, Pinheiro-Franco JL. Sagittal parameters of the spine: biomechanical approach. Eur Spine J 2011; 20 (5): 578-585. DOI: 10.1007/s00586-011-1924-1.
15. Putzier M, Hoff E, Tohtz S, et al. Dynamic stabilization adjacent to single-level fusion: Part II. No clinical benefi t for asymptomatic, initially degenerated adjacent segments after 6 years follow-up. Eur Spine J 2010; 19 (12): 2181-9. DOI: 10.1007/S00586-010-1517-4.
16. Hartmann F, Dietz SO, Hely H, et al. Biomechanical effect of different interspinous devices on lumbar spinal range of motion under preload conditions. Arch Orthop Trauma Surg 2011; 131 (7): 917-26. DOI: 10.1007/s00402-010-1235-8.
17. Korovessis P, Repantis T, Zacharatos S, Zafiropoulos A. Does Wallis implant reduce adjacent segment degeneration above lumbosacral-instrumented fusion? Eur Spine J 2009; 18 (6): 830-40. DOI: 10.1007/s00586-009-0976-y.
18. Simonovich AE, Markin SP, BaykalovAA, Khrapov DV Treatment of degenerative lesions of the lumbar spine with the use of interspinal dynamic implants COFLEX and DIAM. Spinal Surgery 2007; 1: 21-8.
19. Khominets VV, Nadulich КА, Nagorny ЕВ, et al. Features of surgical tactics in the treatment of patients with lumbar degenerative spondylolisthesis. The genius of orthopedics 2018; 24 (2): 221-8.
20. Kim МС, Wang HS, Ju Cl, Kim SW Severe Retrolisthesis at the Adjacent Segment after Lumbar Fusion Combined with Dynamic Stabilization. Korean J Neurotrauma 2017; 13(1): 50-3. DOI: 10.13004/kjnt. 2017.13.1.50.

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