Treatment of single-segment intervertebral fusion with ISOBAR dynamic fixation on adjacent segment for degenerative lumbar diseases

YAN Yuemao; LI Shiping

doi:10.3969/j.issn.1674-666X.2014.02.005

Abstract：Objective To compare the clinical efficacy between single-segment intervertebral fusion with ISOBAR dynamic fixation on adjacent segment and double-segment fusion for the treatment of degenerative lumbar disease (LDD). Methods From June 2009 to September 2010, 50 LDD patients with two levels (L4/5、L5/S1) LDD treated in Yuancheng District People's Hospital of Heyuan City were divided into observation group (posterior decompression + L4/5 ISOBAR dynamic fixation + L5/S1 intervertebral fusion, n = 25) and control group (L4/5 and L5/S1 decompression, fusion and fixation, n = 25) according to different surgical approaches. Operative time, intraoperative estimate blood loss and operation-related complications were recorded; Clinical symptoms were evaluated by visual analogue scale (VAS) and Oswestry disability index (ODI) at preoperation, postoperation and at the last follow-up; Intervertebral height, range of motion (ROM) were measured by lateral X-ray; Intervertebral fusion and implants were observed at the same time. Results All patients were followed up for an average of 42.4 months (32-48 months). Operative time and intraoperative estimate blood loss in observation group were less than those in control group (P <0.05). No anesthesia accident, nerve injuries, deep venous thrombosis were found. At the last follow-up, VAS and ODI scores were all lower than preoperative ones (P <0.05), while there was no statistical difference between 2 groups (P >0.05). Compared with ROM (L2-S1 and L3/4) at preoperation, no obvious loss in observation group were found at the final follow-up (P >0.05);As for intervertebral height of L3/4, the results at the last follow-up improved significantly (P <0.05). In control group, there were statistical difference of ROM and intervertebral height between preoperation and the final follow-up (P <0.05). Postoperative bony fusion rate in observation group and control group was 96% (24/25) and 96 (48/50) respectively. No complications such as dislocation, breakage or loosening of internal fixation hardware were observed. Conclusions Treatment of single-segment intervetebral fusion with ISOBAR dynamic fixation on adjacent segment for LDD patients could prevent the degeneration of adjacent segment with the advantages of less operative time, less estimate blood loss and good ROM. But further follow-up study is necessary to determine the long-term effects of this approach.