The Clinical Outcome Of Retrospective Controlled Study In The Treatment Of Lumbar Disc Herniation By Dynesys And Isobar

Background: lumbar disc herniation is the most common spinal diseases. Discectomyand lumbar fusion is the most treatments of lumbar disc herniation, but they are obviouslyinsufficient. Discectomy will lead persistence of low back pain and lumbar disc herniationrecurrence. Fusion will accelerate the degeneration of adjacent segments, increasing the riskof adjacent vertebral disease degeneration disease. Dynamic stabilization system techniquetheoretically stable lesion segments, maintain the height of the intervertebral space, reservepart of the motor function. It is possible to become a more effective surgical technique thanother traditional operation.Objective:1. Comparative clinical efficacy about discectomy with Dynesys and Isobar dynamicstabilization system to simple discectomy in the treatment of lumbar disc herniation;2. Imaging measurement and analysis the Dynesys and Isobar dynamic fixation systemwith lumbar fusion on adjacent segments of the lumbar spine.Methods:1Time: May2009-2011in May. Grouping: discectomy United Dynesys dynamicfixed (A group)；discectomy United Isobar dynamic fixed (B group); discectomy alone (Cgroup). Study:24-month follow-up record single segmental lumbar disc herniation. Clinicalevaluation of indicators:①lumbar and leg painvisual analogue scale, VAS②Oswestrydisability index, ODI.Imaging evaluation of indicators:①the intervertebral space Ratio,ISR: intervertebral height (leading edge+trailing edge)/vertebral height/2；②surgicalsegment range of motion (range of motion, ROM ’).③intervertebral disc Modic change.Follow-up: outpatient, letters and telephone follow-up. Comparison: Each groupcomparison of preoperative and postoperative follow-up period, the same time period compared among the groups..2. Time: May2009-2011in May. Grouping: discectomy United Dynesys dynamicfixed (A group); discectomy United Isobar dynamic fixed (B group); lumbar fusion (Dgroup). Study:24-month follow-up record single segmental lumbar disc herniation.Evaluation indicators:①rom of motion about the first and the second cranial adjacentsegment (ROM I, ROMⅡ);②Woodend classfication about the first and the second cranialadjacent segment.③the intervertebral space Ratio of the first cranial adjacent segment,ISR’. Follow-up: Outpatient X ray radiography or mail. Comparison: group preoperativeand postoperative follow-up period compared among the groups of the same time periodcomparison.Results:1. A group of25patients were followed up for27±3.25months,15males and10females, mean age40.28years; B group were followed up for21cases, follow-up time of28.45±3.59months,12males and9females, mean age38years; C group were followedup for54cases, follow-up time of26.5±4.35months,34males and20females, mean ageof43.35years old. Three groups VAS and ODI postoperative score significantly improvedwith the preoperative. After24months,C group VAS score is greater than A and B(p<0.05); After1,3,24months, C group ODI score is greater than A and B (p<0.05).After24months, B group intervertebral height have no difference compared preoperative; Agroup decreased14.6%compared to preoperative (p<0.05);C group decreased33.1%compared to preoperative (p<0.01). After24months, C group surgery segment activityincreased significantly (p<0.01); the fixed segment activity of A and B group comparedwith preoperative got some reduction (p<0.05), A group reserved more segmental activitythan B group(p<0.01). After24months,C group had the more cases of Modic change thanother groups（p<0.01）.2. The generally case of A, B group are the same with the Part one. Group D follow-upof22patients,8males and14females, mean age48.7years, follow-up time of27months.After24months, the three groups of the first and second cranial adjacent segment activityhad increased compared with preoperative, the D group increased significantly (p<0.01),Aand B group had increased too(p<0.05). After24months, the three groups of the firstcranial adjacent segment Woodend classification had increased compared with preoperative, the D group increased significantly (p<0.01),A and B group had increased too(p<0.05)；thesecond cranial adjacent segment had nothing change(p>0.05). After24months,the ISR’gotnothing changed(p>0.05).Conclusion:1. Discectomy united Dynesys and Isobar dynamic fixed non-fusion for lumbar discherniation get better clinical efficacy than discectomy alone;2. Both Dynesys of Isobar can maintain the postoperative intervertebral height;3. Two dynamic systems achieve the stability of the fixed segment and retainedsegment motor function, which Dynesys compared Isobar get the better effect in the rangeof motion with regard to reservations;4. The effection of the adjacent segment by lumbar dynamic stabilization system isless than lumbar fusion, but there is a possibility in accelerating adjacent segmentdegeneration.