Dynesys非融合技术治疗腰椎间盘突出症8年临床随访

Minimum eight-year follow-up of lumbar disc herniation treated with Dynesys nonfusion dynamic stabilization system

背景:Dynesys动态稳定系统是非融合技术最常见的手术方式之一,短期临床疗效满意,但长期疗效鲜有报道。目的:探讨Dynesys非融合技术治疗腰椎间盘突出症的长期疗效。方法:回顾性分析2008年2月至2011年2月因腰椎间盘突出症接受Dynesys非融合技术治疗的71例患者的临床资料。收集患者术前、术后4年及末次随访的临床及影像学资料,包括疼痛视觉模拟评分(VAS)、日本骨科协会评分(JOA)、Oswestry功能障碍指数(ODI)、手术节段及邻近节段椎间活动度、椎间隙高度、椎间盘退变Pfirrmann分级。结果:最终64例纳入分析,随访时间8.2~9.3年,平均(8.8±0.3)年。术后4年及末次随访时,腰痛及腿痛VAS评分、JOA评分、ODI较术前明显改善(P<0.05);手术节段椎间活动度,与术前比较,显著降低(P<0.05);手术节段椎间隙高度,与术前比较,差异无统计学意义(P>0.05);上位邻节段椎间隙高度较术前有所降低,活动度有所增加,但差异无统计学意义(P>0.05)。术后各随访时间点手术节段以及上位邻近节段椎间隙高度、椎间活动度差异均无统计学意义(P>0.05)。Pfirrmann分级显示,术后4年时手术节段总改善率为41.1%,无明显改变率为54.8%,退变加重率为4.1%;邻近节段的退变加重率为12.6%。末次随访时,手术节段总改善率为22.9%,无明显改变率为69.9%,退变加重率为6.9%;邻近节段的退变加重率为17.2%。随访期间1例发生椎间盘突出复发,其余未见螺钉松动、断裂、失效等相关并发症。结论:Dynesys非融合技术治疗腰椎间盘突出症,在长期随访中可以有效缓解腰痛及腿痛,并在保证脊柱稳定性的前提下,保留手术节段一定的椎间活动度,可延缓邻近节段退变的进程,从而获得满意的长期临床疗效。

Background:Dynesys dynamic stabilization system is one of the most common nonfusion surgical methods.Its short-term clinical efficacy has been proved to be satisfactory,but long-term efficacy is rarely reported.Objective:To investigate minimum eight-year follow-up of lumbar disc herniation treated with nonfusion dynamic stabilization system.Methods:Clinical data of 61 patients with lumbar disc herniation who were treated by Dynesys nonfusion dynamic stabilization system in our hospital between February 2008 to February 2011 were retrospectively analyzed.The clinical and radiographic data of these patients were collected,such as visual analogue scale(VAS),Japanese Orthopaedic Association(JOA)score,Oswestry disability index(ODI),range of motion(ROM),the disc heights of stabilized segments and proximal adjacent segments.Disc degeneration was classified by the Pfirrmann grade.Results:A total of 53 patients were eventually enrolled in the analysis.The mean follow-up period was(8.8±0.3)years(range,8.2-9.3 years).Compared with preoperative ones,VAS,ODI and JOA scores were significantly improved at 4 years after surgery and the final follow-up(P<0.05);the ROM of surgical segments were significantly decreased(P<0.05);the height of the intervertebral space of the surgical segments was not significantly changed(P>0.05);the height of upper adjacent intervertebral space was slightly reduced,and intervertebral motion of upper adjacent segment was slightly increased,but no significant difference was found(P>0.05).There were no significant differences in disc heights or intervertebral motions of surgical segment or upper adjacent segment between any follow-up time points(P>0.05).The Pfirrmann classification showed that the total improvement rate of surgical segments was 41.1%,54.8%with no change and 4.1%with more degeneration 4 years after surgery.At the last follow-up,the improvement rate of surgical segments was 22.9%,69.9%with no change and 6.9%with more degeneration.Pfirrmann classification showed the aggravation rate of degeneration in adjacent segments was 12.6%at 4 years after surgery and 17.2%at the last follow-up.Intervertebral disc herniation occurred in the surgical segments in one patient during follow-up,but no other implant complications such as screw breakage and screw loosening were documented.Conclusions:Nonfusion dynamic stabilization system in the treatment of lumbar disc herniation can effectively relieve low back pain and leg pain during long-term follow-up and maintain a certain degree of lumbar activity at the operative segments while ensuring the stability of the spine,thus delaying the degeneration of adjacent segments and demonstrating satisfactory clinical and radiological long-term results.