Document Detail


Adjacent segment mobility after rigid and semirigid instrumentation of the lumbar spine.
MedLine Citation:
PMID:  19455004     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
STUDY DESIGN: Retrospective radiographic analysis of lumbar spine range of motion (ROM) after monosegmental fusion and posterior dynamic stabilization at the level L4-L5. OBJECTIVE: Comparison of segmental ROM at the index level and the cranial and caudal adjacent levels and of global lumbar spine ROM after monosegmental fusion and posterior dynamic stabilization. SUMMARY OF BACKGROUND DATA: The postulated advantage of nonfusion technology compared with fusion is based on the assumption that preservation of motion at the treated segment reduces the incidence of adjacent segment effects. Therefore, it is imperative to provide evidence that dynamic stabilization devices avoid hypermobility at the adjacent segments because this might substantiate a protective effect on the adjacent segments. METHODS: Twenty-six patients with low back pain and claudication due to degenerative instability at the level L4-L5 with concomitant spinal stenosis were treated either with decompression and Dynesys (n = 11) or with decompression and fusion (n = 15). All patients underwent flexion/extension radiographs before surgery and at latest follow-up. ROM was assessed at the index level (L4-L5), the cranial/caudal adjacent levels (L3-L4/L5-S1), and at the lumbar spine from L2 to S1. RESULTS: There was a significant reduction of the global ROM of the lumbar spine (L2-S1) and the segmental ROM at the index level (L4-L5) in the fusion group, whereas adjacent level ROM did not change significantly. In the Dynesys group, no significant changes of global lumbar spine ROM (L2-S1) and segmental ROM (index level and cranial/caudal adjacent levels) were seen. CONCLUSION: This study shows that neither monosegmental instrumented fusion nor monosegmental posterior dynamic stabilization with Dynesys alter the ROM of the cranial and caudal adjacent levels. Consequently, monosegmental posterior dynamic stabilization with Dynesys has no effect with regard to adjacent segment mobility compared with monosegmental fusion.
Authors:
Balkan Cakir; Charles Carazzo; René Schmidt; Thomas Mattes; Heiko Reichel; Wolfram Käfer
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Spine     Volume:  34     ISSN:  1528-1159     ISO Abbreviation:  Spine     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-05-20     Completed Date:  2009-08-25     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7610646     Medline TA:  Spine (Phila Pa 1976)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1287-91     Citation Subset:  IM    
Affiliation:
Department of Orthopaedic Surgery, University of Ulm, Ulm, Germany. balkan.cakir@rku.de
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MeSH Terms
Descriptor/Qualifier:
Activities of Daily Living
Aged
Biomechanics
Disability Evaluation
Female
Humans
Internal Fixators / adverse effects*
Intervertebral Disk Displacement / surgery*
Joint Instability / radiography,  surgery
Lumbar Vertebrae / anatomy & histology,  physiology,  surgery*
Male
Materials Testing / instrumentation
Middle Aged
Movement
Outcome Assessment (Health Care) / methods
Patient Satisfaction
Pliability
Postoperative Complications / etiology,  pathology,  physiopathology*
Posture
Prosthesis Design / instrumentation
Prosthesis Failure
Range of Motion, Articular / physiology*
Retrospective Studies
Spinal Fusion / adverse effects*,  instrumentation,  methods
Spinal Stenosis / surgery
Stress, Mechanical
Treatment Outcome
Weight-Bearing

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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