| Background: With intervertebral disc degeneration as the core, lumbar degenerativedisease is the most common disease of the motor system in clinical. Although thetraditional operation can achieve good short-term effect, progressive changes after surgerysuch as degeneration acceleration and functional impairment, significantly affect daily lifeand labour. It was reported that dynamic stabilization has obvious advantages in the theoryand clinical effect compared with traditional surgery and strict long-term controlled clinicalstudies were rarely seen. There are differences on the choice of operation and technicalspecification.Objective: To assess the clinical efficacy of any radiographic changes caused bydynamic fixation combined with endoscopic discectomy in the treatment of lumbar discherniation by comparing with the traditional surgery.Methods: This study choose patients with single segmental lumbar intervertebral discprotrusion in southwest hospital, third military medical university frome November2009toApril2011. There were108cases of postoperative patients which were follow-up over36months. The patients were treated with discectomy combined with Dynesys (Group A,n=23), discectomy combined with Isobar (Group B, n=21), discectomy combined withK-Rod (Group C, n=20), discectomy (Group D, n=23), lumbar fusion (Group E, n=22),respectively. Neither of them have pre-existing degeneration changes in adjacent segment.The VAS, ODI and MacNab criteria were employed before and after surgery to assess theclinical efficacy. All preoperative patients film lumbar flexion and lateral X-Ray and MRIas a routine examination. At follow-up, the patient film lumbar flexion and lateral X-Rayand MRI (2-year follow-up).The imaging data would eventually be collected and compared.①Intervertebral space ratio (ISR): We measured the height of the leading and trailingedges of the intervertebral space during lateral lumbar X-ray (standing position), calculatedthe ratio of the mean and the height of the first cephalic vertebral leading edge, observed changes in the ratio between intervertebral space heights of the surgical segment and theadjacent cephalic segment before and after surgery.②Range of motion (ROM): Thesegmental lordotic angle was measured in lumbar flexion and lateral radiography, and thedifference was the ROM of the measured segment. Changes in the ROM of the surgicalsegment and the overall lumbar ROM before and after surgery were observed.③In MRIimaging of preoperative and follow-up, we compared the changes of surgical segmentendplate inflammation (modic changes) and Woodend criteria of surgical adjacent segment.Results: There were no statistically significant differences in gender, age, responsiblesegment and other general data between two groups (P>0.05), and the two groups were thuscomparable. Through VAS and ODI score to evaluate symptoms improved effect,symptoms were significantly improved compared with preoperative at the time of the lastfollow-up. The dynamic fixation group (group A, B, C) improvement effect is superior todiscectomy (group D) and lumbar fusion (group E). The comparison between three kinds ofdynamic fixation group has no obvious difference. The imaging data (lateral andextend-flex lumbar spine films, MRI of lumbar) would eventually be collected andcompared.①The change of Intervertebral disc height: DHR dropped by15.6%(p<0.05),7.4%(p>0.05),9.5%(p<0.05),31.8%(p<0.01)at operative level of group A, B, C, Drespectively. DHR dropped by19.5%(p<0.01)at adjacent level of group E.②The changeof ROM: ROM of dynamic fixation system (group A, B, C) dropped at operative level, butit was reserved70%,50%,50%respectively at36M. Group D increased by66%. ROM ofthe5group was increased at adjacent level and the biggest increasement is group E (101%，p<0.01).③Degeneration of the intervertebral disc: There were1case of Modic changes ingroup A,0case in group B,1case in group C,5cases in group D. Woodend classificationof group A, B, C, E increased at first adjacent level.Conclusion:1. Dynamic fixation combined with discectomy has clear short-term effects in thetreatment of lumbar disc herniation;2. Compared with discectomy, it can maintain the original motor functions of thesurgical segment, maintain the postoperative intervertebral height and alleviatedegeneration of the affected segment;3. Compared with lumbar fusion, dynamic fixation system maintaining the motor function, have less effect on the adjacent segment, but adjacent segment have progressivedegeneration.4. In terms of maintaining the original motor functions, Dynesys dynamic fixationsystem is better than that of Isobar and K-Rod system.And in terms of maintaining theintervertebral height, Isobar dynamic fixation system is superior to the Dynesys and K-Rodsystem. There is no obvious difference influence on the adjacent segment of the three kindsof dynamic fixation system.5. Master indication and contraindication of dynamic fixation strictly. |
PDF Full Text Request