Comparative Study Of Clinical Efficacy Of Dynesys Dynamic Internal Fixation And Posterior Fusion In The Treatment Of L4 / 5 Single - Segment Degenerative Diseases

Objective:To compare the recent clinical efficacies andimageology results between Dynesys dynamic internal fixation and posterior lumbar interbody fusion (PLIF) in the treatment of L4/5single segmental lumbar degenerative disease.Methods:A retrospective analysis on 30 cases ofL4/5 spinal stenosis patients admitted inour department from January 2011 to January 2014was conducted.The follow-up data were complete. The posterior lumbar decompression combined with vertebral pedicle dynamic stabilization system (observation group, dynesys,15 cases) and posterior lumbar decompressioninterbody fusion (control group, PLIF,15 cases). The operation time, intraoperativebleeding and postoperativeambulation time in two cases were collected respectively. The preoperative and follow-upclinical curative efficacies were evaluated according to Oswestry disability index (ODI), visual analogue scale (VAS) and Japanese Orthopedic Association (JOA) score; The intervertebral heights (H) ofsuperior segment (L3/4) and inferior segment(L5/S1)as well as lumbarrange of motion (ROM)were measured respectively through collecting preoperative and postoperative lumbar anteroposterior and lateral dynamic radiographs.The lumbar X-ray wasscored byUCLA intervertebral disc degeneration grading standards. The preoperative various indexes andlast follow-up indexes were recordedin two groups. The data were analyzed using SPSS 17.0 software.The intra-group and inter-group differences in various indexes were compared before and after operation.P<0.05 showed the result had statistical significance.Results:All cases were all followed up.The follow-up rate was 100%. The averagefollow-up time was 24.93±6.79 months in observation group and24.60±7.30 months in control group. The postoperative VAS, JOA, ODI score in observation group were improved than preoperative thoseof control group (P<0.05). Theadjacent segmental intervertebral spaceheight inlast follow-uphad different degree of lossin two groups.There was no significantly differentin observation group(P>0.05) and was significantly different in control group (P<0.05) before and after the operation. The postoperative superior and inferior adjacent segmental ROMs were increased in different degrees in two groups. The difference betweenadjacent segments in observation group was not significant (P>0.05); The difference betweenadjacent segments in control group was significant (P<0.05). The postoperative superior and inferior adjacent segmental UCLA intervertebral space degenerationscoresin two groups were significantly increased. The difference betweenadjacent segments in observation group was not significant (P>0.05); The difference betweenadjacent segments in control group was significant (P<0.05).Conclusion:The curative efficacy ofDynesys dynamic stabilization system was equivalent with that of posterior lumbar interbody fusion in the treatment of lumbar degenerative disease. But the former had advantages includingshorter operation time, less bleeding, postoperative earlier ambulation time than the latter. In addition, Dynesys dynamic stabilization system can delay the degeneration of the adjacent segments.