Background： Many clinical studies over the past decade have indicated positive outcomes for patients treated with Dynesys dynamic stabilization for lumbar degenerative disease. However, long-term outcomes of Dynesys ...Background： Many clinical studies over the past decade have indicated positive outcomes for patients treated with Dynesys dynamic stabilization for lumbar degenerative disease. However, long-term outcomes of Dynesys for lumbar spinal stenosis are rarely reported. The aim of this study was to analyze the long-term clinical and radiologic outcomes for patients with lumbar spinal stenosis treated with Dynesys stabilization. Methods： Thirty-eight patients with lumbar spinal stenosis were treated with Dynesys stabilization from July 2008 to March 2010. The minimal duration of follow-up was 72 months. The patients were divided into stenosis and spondylolisthesis groups according to degenerative spondylolisthesis. Clinical outcomes were evaluated using the Oswestry Disability Index （ODI） and visual analog scale （VAS）. Radiographic evaluations included range of motion （ROM） and the disc heights of stabilized segments and the upper adjacent segments. We also evaluated the occurrence of radiographic and symptomatic adjacent segment degeneration （ASD）. Results： There were 23 patients in stenosis group and 15 patients in spondylolisthesis group. The ODl scores were significantly improved at the final follow-up evaluation, as compared to the baseline values （ 16.1± 5.7 vs. 57.2 ± 14.2, t = 61.4 l, P 〈 0.01 ）. The VA S scores for back and leg pain were significantly improved from 4.82 ±0.89 and 4.04 ± 0.82 preoperatively to 0.93± 0.61 and 0.54 ± 0.51 postoperatively （t = 6.59, P 〈 0.01, and t = 5.91, P 〈 0.01, respectively）. There were no differences between the two groups with respect to VAS and ODI scores. The ROM of stabilized segments decreased significantly from 7.8°± 2.4° to 4.5° ± 1.5° （t = 7.18, P 〈 0.05）, while the upper adjacent segments increased significantly from 8.3° ± 2.4° to 10.4° ± 2.4° （t = 2.87, P = 0.01）. The change in disc height of stabilized segments was not significant （11.9 ±2.1 preoperatively vs. 12.5 ± 1.5 postoperatively, t = 1.43, P = 0.15）, whereas the decrease in disc height of the upper adjacent segments was significant （12.5 ±2.0 preopcratively vs. 11.0 ± 1.7 postoperatively, t = 2.94, P = 0.01 ）. The occurrence of radiographic and symptomatic ASD was 16% （6/38） and 3% （1/38）, respectively. Conclusions： Decompression and Dynesys stabilization for lumbar stenosis with or without spondylolisthesis showed good long-term clinical and radiographic results. Lumbar stenosis with or without Grade I spondylolisthesis, particularly in patients 〈60 years of age with mild-to-moderate lumbar disc degeneration, would be one of the main indications for the Dynesys system.展开更多
BACKGROUND Radiologic adjacent segment degeneration(ASDeg)can occur after spinal surgery.Adjacent segment disease(ASDis)is defined as the development of new clinical symptoms corresponding to radiographic changes adja...BACKGROUND Radiologic adjacent segment degeneration(ASDeg)can occur after spinal surgery.Adjacent segment disease(ASDis)is defined as the development of new clinical symptoms corresponding to radiographic changes adjacent to the level of previous spinal surgery.Greater pre-existing ASDeg is generally considered to result in more severe ASDis;nonetheless,whether the ASDeg status before index surgery influences the postoperative risk of revision surgery due to ASDis warrants investigation.AIM To identify possible risk factors for ASDis and verify the concept that greater preexisting ASDeg leads to more severe ASDis.METHODS Data from 212 patients who underwent posterior decompression with Dynesys stabilization from January 2006 to June 2016 were retrospectively analyzed.Patients who underwent surgery for ASDis were categorized as group A(n=13),whereas those who did not were classified as group B(n=199).Survival analysis and Cox proportional hazards models were used to compare the modified Pfirrmann grade,University of California-Los Angeles grade,body mass index,number of Dynesys-instrumented levels,and age.RESULTS The mean time of reoperation was 7.22(1.65–11.84)years in group A,and the mean follow-up period was 6.09(0.10–12.76)years in group B.No significant difference in reoperation risk was observed:Modified Pfirrmann grade 3 vs 4(P=0.53)or 4 vs 5(P=0.46)for the upper adjacent disc,University of California-Los Angeles grade 2 vs 3 for the upper adjacent segment(P=0.66),age of<60 vs>60 years(P=0.9),body mass index<25 vs>25 kg/m2(P=0.3),and sex(P=0.8).CONCLUSION Greater preexisting upper ASDeg was not associated with a higher rate of reoperation for ASDis after Dynesys surgery.Being overweight tended to increase reoperation risk after Dynesys surgery for ASDis.展开更多
目的:探讨单通道内镜(Delta)下单侧椎板切开术行双侧减压术(unilateral laminoto my for bilateral decompression,ULBD)治疗腰椎融合术后邻椎病(adjacent segment disease,ASD)的临床疗效。方法:回顾性分析2021年1月至2023年1月采用脊...目的:探讨单通道内镜(Delta)下单侧椎板切开术行双侧减压术(unilateral laminoto my for bilateral decompression,ULBD)治疗腰椎融合术后邻椎病(adjacent segment disease,ASD)的临床疗效。方法:回顾性分析2021年1月至2023年1月采用脊柱内镜ULBD治疗的腰椎融合术后ASD 24例,男10例,女14例;年龄54~77(59.2±3.6)岁;L_(2,3)2例,L_(3,4)16例,L_(5)S_(1)6例。记录患者手术时间、术中出血量,分别于术前、术后1周及术后1、3、6个月记录下肢痛疼痛视觉模拟评分(visual analogue scale,VAS)及Oswestry功能障碍指数(Oswestry disability index,ODI),采用改良MacNab评分标准评价临床疗效。结果:24例患者均顺利完成手术,术中无神经损伤、硬膜损伤脑脊液漏,手术时间(90.3±11.8)min,术中出血量(35.3±5.3)ml,住院时间(14.4±2.1)d。24例患者均获得6个月的随访。ODI、VAS分别由术前的(51.25±5.48)%、(6.88±1.23)分改善至术后1周的(9.29±1.76)%、(1.13±0.95)分(P<0.05);术后1个月ODI、VAS(9.17±1.90)%、(1.67±0.82)分较术后1周改善(P<0.05)。术后1、3、6个月ODI及VAS比较,差异无统计学意义(P>0.05)。末次随访时,按照改良MacNab标准,优8例,良13例,可3例。结论:单通道内镜(Delta)下ULBD手术治疗腰椎融合术后ASD患者,具有创伤小、出血少、手术时间短、术后恢复快等优势,临床疗效满意。展开更多
目的：比较融合与非融合术治疗腰椎单节段退变性疾病的临床疗效及其对相邻节段的影响。方法2011年5月－2012年6月，收集49例，按手术方法不同分两组，观察组21例使用弹性棒非融合固定术，对照组28例椎间融合固定术。采用疼痛视觉模拟评...目的：比较融合与非融合术治疗腰椎单节段退变性疾病的临床疗效及其对相邻节段的影响。方法2011年5月－2012年6月，收集49例，按手术方法不同分两组，观察组21例使用弹性棒非融合固定术，对照组28例椎间融合固定术。采用疼痛视觉模拟评分法（ visual analog scale ，VAS）评价临床疗效，并通过X线片测量腰椎各间隙高度。结果所有病例均随访16～34个月，平均26．7个月，两组末次随访时VAS评分较术前都明显降低，差异有统计学意义（P＜0．05）。两组术后1周时VAS评分差异无统计学意义（P＞0．05）。观察组末次随访时上、下位节段椎间隙高度与术前比较退变不显著，差异不具有统计学意义（P＞0．05）；对照组上、下位节段椎间隙高度末次随访时与术前比较减少明显，差异具有统计学意义（P＜0．05）。结论融合与非融合固定治疗单间隙腰椎退变性都取得较好的临床疗效，非融合术会降低相邻节段退变的发生。展开更多
文摘Background： Many clinical studies over the past decade have indicated positive outcomes for patients treated with Dynesys dynamic stabilization for lumbar degenerative disease. However, long-term outcomes of Dynesys for lumbar spinal stenosis are rarely reported. The aim of this study was to analyze the long-term clinical and radiologic outcomes for patients with lumbar spinal stenosis treated with Dynesys stabilization. Methods： Thirty-eight patients with lumbar spinal stenosis were treated with Dynesys stabilization from July 2008 to March 2010. The minimal duration of follow-up was 72 months. The patients were divided into stenosis and spondylolisthesis groups according to degenerative spondylolisthesis. Clinical outcomes were evaluated using the Oswestry Disability Index （ODI） and visual analog scale （VAS）. Radiographic evaluations included range of motion （ROM） and the disc heights of stabilized segments and the upper adjacent segments. We also evaluated the occurrence of radiographic and symptomatic adjacent segment degeneration （ASD）. Results： There were 23 patients in stenosis group and 15 patients in spondylolisthesis group. The ODl scores were significantly improved at the final follow-up evaluation, as compared to the baseline values （ 16.1± 5.7 vs. 57.2 ± 14.2, t = 61.4 l, P 〈 0.01 ）. The VA S scores for back and leg pain were significantly improved from 4.82 ±0.89 and 4.04 ± 0.82 preoperatively to 0.93± 0.61 and 0.54 ± 0.51 postoperatively （t = 6.59, P 〈 0.01, and t = 5.91, P 〈 0.01, respectively）. There were no differences between the two groups with respect to VAS and ODI scores. The ROM of stabilized segments decreased significantly from 7.8°± 2.4° to 4.5° ± 1.5° （t = 7.18, P 〈 0.05）, while the upper adjacent segments increased significantly from 8.3° ± 2.4° to 10.4° ± 2.4° （t = 2.87, P = 0.01）. The change in disc height of stabilized segments was not significant （11.9 ±2.1 preoperatively vs. 12.5 ± 1.5 postoperatively, t = 1.43, P = 0.15）, whereas the decrease in disc height of the upper adjacent segments was significant （12.5 ±2.0 preopcratively vs. 11.0 ± 1.7 postoperatively, t = 2.94, P = 0.01 ）. The occurrence of radiographic and symptomatic ASD was 16% （6/38） and 3% （1/38）, respectively. Conclusions： Decompression and Dynesys stabilization for lumbar stenosis with or without spondylolisthesis showed good long-term clinical and radiographic results. Lumbar stenosis with or without Grade I spondylolisthesis, particularly in patients 〈60 years of age with mild-to-moderate lumbar disc degeneration, would be one of the main indications for the Dynesys system.
基金The study was approved by our institutional review board,Research Ethics Committee China Medical University and Hospital,Taichung,Taiwan(Protocol No.:CMUH108-REC2-133).
文摘BACKGROUND Radiologic adjacent segment degeneration(ASDeg)can occur after spinal surgery.Adjacent segment disease(ASDis)is defined as the development of new clinical symptoms corresponding to radiographic changes adjacent to the level of previous spinal surgery.Greater pre-existing ASDeg is generally considered to result in more severe ASDis;nonetheless,whether the ASDeg status before index surgery influences the postoperative risk of revision surgery due to ASDis warrants investigation.AIM To identify possible risk factors for ASDis and verify the concept that greater preexisting ASDeg leads to more severe ASDis.METHODS Data from 212 patients who underwent posterior decompression with Dynesys stabilization from January 2006 to June 2016 were retrospectively analyzed.Patients who underwent surgery for ASDis were categorized as group A(n=13),whereas those who did not were classified as group B(n=199).Survival analysis and Cox proportional hazards models were used to compare the modified Pfirrmann grade,University of California-Los Angeles grade,body mass index,number of Dynesys-instrumented levels,and age.RESULTS The mean time of reoperation was 7.22(1.65–11.84)years in group A,and the mean follow-up period was 6.09(0.10–12.76)years in group B.No significant difference in reoperation risk was observed:Modified Pfirrmann grade 3 vs 4(P=0.53)or 4 vs 5(P=0.46)for the upper adjacent disc,University of California-Los Angeles grade 2 vs 3 for the upper adjacent segment(P=0.66),age of<60 vs>60 years(P=0.9),body mass index<25 vs>25 kg/m2(P=0.3),and sex(P=0.8).CONCLUSION Greater preexisting upper ASDeg was not associated with a higher rate of reoperation for ASDis after Dynesys surgery.Being overweight tended to increase reoperation risk after Dynesys surgery for ASDis.
文摘目的：比较融合与非融合术治疗腰椎单节段退变性疾病的临床疗效及其对相邻节段的影响。方法2011年5月－2012年6月，收集49例，按手术方法不同分两组，观察组21例使用弹性棒非融合固定术，对照组28例椎间融合固定术。采用疼痛视觉模拟评分法（ visual analog scale ，VAS）评价临床疗效，并通过X线片测量腰椎各间隙高度。结果所有病例均随访16～34个月，平均26．7个月，两组末次随访时VAS评分较术前都明显降低，差异有统计学意义（P＜0．05）。两组术后1周时VAS评分差异无统计学意义（P＞0．05）。观察组末次随访时上、下位节段椎间隙高度与术前比较退变不显著，差异不具有统计学意义（P＞0．05）；对照组上、下位节段椎间隙高度末次随访时与术前比较减少明显，差异具有统计学意义（P＜0．05）。结论融合与非融合固定治疗单间隙腰椎退变性都取得较好的临床疗效，非融合术会降低相邻节段退变的发生。
