Saratov JOURNAL of Medical and Scientific Research

The choice of performing tactics of dorsal decompressive-stabilizing interventions on the lumbar spine for the prevention of degenerative disease of an adjacent segment

Year: 2020, volume 16 Issue: №3 Pages: 762-768
Heading: neurosurgery Article type: Original article
Authors: Byvaltsev V.A., Kalinin А.А., Pestryakov Yu.Ya., Spiridonov A.V.
Organization: Clinical Hospital "Russian Railways Medicine", Irkutsk State Medical University, Krasnoyarsk Regional Clinical Hospital, Russian Railways

Purpose: Comparative analysis of the results of dorsal decompressive-stabilizing interventions (DDSI) on the lumbar spine for substantiating the method of prevention of adjacent segment degenerative disease (ASDd). Material and Methods: 79 patients were included in the retrospective research, 2 groups were identified: in group I (n=41) single-level research, in group II (n=38) two-level DDSI, with rigid stabilization of the spinal motion segment, in the presence of signs of its degeneration was made. Clinical outcomes, instrumental data and surgical complications were evaluated. Results: It was a decrease of pain syndrome in the postoperative period, an improvement in the quality of life in two groups (p<0.001). In the inter-group comparison of the visual analog scale (VAS) — back, legs, ODI, SF-36 in group II, the results at discharge were lower than in group I (p<0.001), after 3.6.12 months there is a comparable improvement in a quality of life and a decrease in pain by VAS in both groups (p>0.05). In the distant period (24, 36 months), clinical results are better in-group II (p<0.05). The number of late surgical complications and revision interventions is higher in a group II (17.1 and 4.0%) (p<0.05). Conclusion: Preventive rigid stabilization of adjacent segment with signs of initial degeneration improves long-term results, reduces the number of repeated operations, despite the larger volume of primary medical intervention.

1. Konovalov NA, Nazarenko AG, Asyutin DS. Modern treatments for degenerative disc diseases of the lumbosacral spine. A literature review. Issues of Neurosurgery 2016; 80 (4): 102-8.
2. Belykh Е, Kalinin АА, Martirosyan NL, et al. Facet Joint Fixation and Anterior, Direct Lateral, and Transforaminal Lumbar Interbody Fusions for Treatment of Degenerative Lumbar Disc Diseases: Retrospective Cohort Study of a New Minimally Invasive Technique. World Neurosurg 2018; (114): 959-68.
3. Kaner T, Sasani M, Oktenoglu T, Ozer AF. Dynamic stabilization of the spine: a new classification system. Turk Neurosurg 2010; 20 (2): 205-15.
4. Gomleksiz C, Sasani M, Oktenoglu T, Ozer AF. A short history of posterior dynamic stabilization. Adv Orthop 2012; 2012: 629-98.
5. Pestryakov YY, Spiridonov AV, Kalinin AA, Byvaltsev VA. Incidence and risk factors of and risk factors of adjacent lumbar segment degenerative disease following dorsal decompression — stabilizing surgery. Modern problems of science and education 2020; (2). URL: 29701.
6. Senegas J. Mechanical supplementation by non-rigid fixation in degenerative intervertebral lumbar segments: the Wallis system. Eur Spine J 2002;11 (Suppl 2): 164-9.
7. Carragee EJ, Chen Y, Tanner CM, et al. Provocative dis-cography in patients after limited lumbar discectomy: A controlled randomized study of pain response in symptomatic and asymptomatic subjects. Spine 2000; 25: 3065-71.
8. Chan AK, Sharma V, Robinson LC, et al. Summary of Guidelines for the Treatment of Lumbar Spondylolisthesis. Neurosurg Clin N Am 2019; 30 (3): 353-64.
9. Fujiwara A, Lim TH, An HS, et al. The effect of disc degeneration and facet joint osteoarthritis on the segmental flexibility of the lumbar spine. Spine 2000; (25): 3036-44.
10. Pfirrmann CW, Metzdorf A, Zanetti M, et al. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine 2001; (26): 1873-8.
11. Shen S, Wang H, Zhang J, et. al. Diffusion Weighted Imaging, Diffusion Tensor Imaging, and T2
Mapping of Lumbar Intervertebral Disc in Young Healthy Adults. Iran J Radiol 2016; 13(1):e30069.
12. Liang J, Dong Y, Zhao H. Risk factors for predicting symptomatic adjacent segment degeneration requiring surgery in patients after posterior lumbar fusion. J Orthop Surg Res 2014; (9): 97.
13. Ha KY, Son JM, Im JH, Oh IS. Risk factors for adjacent segment degeneration after surgical correction of degenerative lumbar scoliosis. Indian J Orthop 2013; 47 (4): 346-51.
14. Cai X, Sun M, Huang Y, et al. Biomechanical Effect of L4 — L5 Intervertebral Disc Degeneration on the Lower Lumbar Spine: A Finite Element Study. Orthop Surg 2020; 12 (3): 917-30.
15. WuAM,ZhouY, Li QL, et al. Interspinous spacer versus traditional decompressive surgery for lumbar spinal stenosis: a systematic review and meta-analysis. PLoS One 2014; 9 (5): 97142.
16. Hadlow SV, Fagan AB, Hillier TM, Fraser RD. The Graf ligamentoplasty procedure. Comparison with posterolateral fusion in the management of low back pain. Spine (Phila Pa 1976) 1998; 23 (10): 1172-9.
17. Bothmann M, Kast E, Boldt GJ, Oberle J. Dynesys fixation for lumbar spine degeneration. Neurosurg Rev 2008; 31 (2): 189-96.
18. Bozkus H, Senoglu M, Baek S, et al. Dynamic lumbar pedicle screw-rod stabilization: in vitro biomechanical comparison with standard rigid pedicle screw-rod stabilization. J Neurosurg Spine 2010; 12(2): 183-9.
19. Manchikanti L, Nampiaparampil DE, Manchikanti KN, et al. Comparison of the efficacy of saline, local anesthetics, and steroids in epidural and facet joint injections for the management of spinal pain: A systematic review of randomized controlled trials. Surg Neurol Int 2015; 6 (Suppl 4): 194-235
20. Ghasemi AA. Adjacent segment degeneration after posterior lumbar fusion: An analysis of possible risk factors. Clin Neurol Neurosurg 2016; (143): 15-8.

2020_03_762-768.pdf732.63 KB

No votes yet