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Treatment for single-level degenerative disc disease with posterior dynamic stabilization: Minimum 5 years follow up

摘要


Background: In recent years, increasing numbers of patients have exhibited degenerative disc disease (DDD). However, diagnosis of DDD is difficult. Discography, particularly provocative discography, is the most important diagnostic tool for DDD. In addition, treatment of DDD remains controversial. Traditionally, spinal fusion is considered the gold standard for treating DDD. But adjacent segment disease (ASD) remains a problem after applying fusion techniques. Numerous studies have analyzed the effectiveness and safety of treating DDD through posterior dynamic stabilization by using the Dynesys system (Zimmer Spine, Memphis, TN, USA). However, the indications for treatment using Dynesys remain controversial. Purpose: The aim of this study was to record the surgical outcome of applying posterior dynamic instrumentation to treat single-level DDD in carefully selected patients. Methods: We retrospectively reviewed patients with a diagnosis of single level DDD between July 2007 and September 2011. Nineteen patients were treated at our institution with posterior dynamic stabilization (Dynesys, Zimmer Spine, Memphis, TN, USA). Nineteen patients were enrolled in the study, and seven of them received a discogram to determine the pain origin from DDD. Results: For all patients, the mean NRS decreased from 5.11 ± 1.55 preoperatively to 2.26 ± 1.37 postoperatively (p = 0.001). The mean ODI decreased from 41.47 preoperatively to 14.95 postoperatively (p < 0.001). There were four cases with radiographic halo signs at one screw, and two cases with the L5 screw broken (one right, one on both side). None of these patients had ASD that relates to the development of spondylolisthesis and no major surgery- related complication was noted at follow up. Our outcome assessment questionnaire indicated that successful results were reported by 84.2% (16/19) of patients after at least 5 years of follow up. Conclusion: In conclusion, under careful case selection, patients with single-level DDD treated with Dynesys exhibited satisfactory clinical outcomes at midterm follow-up.

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