Early Efficacy Of Lumbar Disc Herniation Isobar TTL Dynamic Fixation System

BackgroundLumbar disc herniation is a common and significant cause of low back pain. After strict conservative treatment is invalid,10%-20%of the patients require surgery. Spinal fusion technology has gone through a journey of a hundred years. Through a large number of clinical and biomechanical studies, the safety and efficacy of this technology has been fully confirmed, and known as the "gold standard". But the technology itself has drawbacks, such as the loss of fusion segment motor function and increasing the activity of adjacent segments and stress load, which may accelerate the degeneration process of adjacent segment and increasing the risk of adjacent segment disease. To solve the problem brought by the fusion of adjacent segment degeneration, spinal non-fusion concept came into being. IsobarTTL dynamic fixation system can theoretically stabilize dynamic fixed segment, maintain the intervertebral height, keep activity of dynamic fixed segment part, and prevent further degeneration of adjacent segments. It is possible to become a more effective surgical technique than other tradition operation.Objective1.Evaluating the early clinical effect of Isobar TTL dynamic fixation system in the treatment of lumbar disc herniation;2.Evaluating the impact of Isobar TTL dynamic fixation system on dynamic fixed segment and adjacent segments.MethodWe select31patients as samples, whom were diagnosed with lumbar disc herniation at Dongzhimen Hospital between September2011and May2013. All of the31patients were treated with Isobar TTL dynamic fixation system and be followed for at least12months. All patients were taken the lumbar MRI examination before operation. Visual analogue scale (VAS) and Oswestry disability index(ODI) were used to evaluate the postoperative clinical effect. In addition, we also used MacNab standard to evaluate the clinical effect at the last follow-up. We judge the fusion situation according to the Suk standard. We use the range of motion(ROM) and intervertebral space ratio(ISR) to evaluate the change of the dynamic fixed segment and the adjacent segment between preoperative and postoperative.ResultsAll patients were successfully operated according to the original plan and followed up for (16.06±4.49) months. The VAS and ODI were significantly improved at the last follow-up (P<0.01). According to MacNab standard:20cases were excellent,8cases were good,2cases were general and lcase was poor. The excellent and good rate was90.32%。 Up to the final follow-up, no looseness or breakage of the internal fixation and other related complications was observed.27patients achieved the strong fusion according to the Suk standard and the fusion rate was87%. The ROM of dynamic fixed segment at each time point after operation were decreased significantly when compared with those before operation (P<0.01). The ISR of dynamic fixed segment at6months post-operation and12months post-operation were increased significantly when compared with those before operation (P<0.01). There were no significant differences in ISR of adjacent segment before operation and last follow-up (P>0.05).The ROM of the adjacent segment at each time point were increased significantly when compared with those before operation (P<0.01). The ISR of adjacent segment was not changed at12months post-operation and at the last follow-up(P>0.05).ConclusionIsobar TTL dynamic system for lumbar disc herniation presents satisfactory Early clinical results. Isobar TTL dynamic system can not only realize the stability of the fixed segment and retain the motor function of dynamic fixed segmental, but also maintain the fixed intervertebral spaces. Isobar TTL dynamic fixation system has little effect on adjacent segments, and may delay the degeneration of adjacent segments.