Clinical Outcome Of Controlled Study In The Treatment Of Multisegments Disc Degeneration Disease By Dynesys Or Fusion

Background: Multsegments disc degeneration disease is the most complex lumbardegeneration diseases. Lumbar fusion is the most treatments of multsegments discdegeneration disease, but they are obviously insufficient. It will increase the degenerativechange of adjacent level, raising the risk of pseudarthrosis, Low convergence rate, internalfixation loosening etal. Theoretically, lesion segments will be fixed stably, the height of thedisc space be maintained, part of the motor function be reserved with dynamic stabilizationsystem technique. When compared with fusion,clinical effect of the treatment ofmultisegmental disc degenerative diseases and internal fixation complication is unclear.Objective:1. To compare clinical efficacy of mutlsegments Dynesys and fusion in the treatmentof multsegments disc degeneration disease;2. Imaging measurement and analysis the Dynesys with lumbar fusion to furtherdiscuss the pros and cons.Methods:1Time: Jan2010-2012in Mar. Grouping: Dynesys system for group A(23patients，15males，8females)；lumbar fusion for group B(22cases，10males，12females). Study:patients with double segments DDD was followed up for24-month. Indicators forevaluation conclude：1)lumbar and leg pain VAS；2)ODI；3)surgical segment theintervertebral space Ratio(ISR)；4)surgical segment range of motion；5)adjacent segmentROM and ISR,total lumbar ROM.2. Time: Feb2010-2012in Mar. Grouping: Dynesys system for group C(15cases,9males,6females); lumbar fusion for group D(16cases,10males,6males). Study: patientswith multisegments(≧3) DDD were followed up for24months. Indicators for evaluationconclude:the same to part1. Results:1. Group A were followed up for27.6±5.7months,whose average age was42.6years old; Group B average age was58.6years old，followed up for28.7±4.8months. Agroup of low back and leg pain scores from preoperative4.9±1.3,2.5±0.6to24monthsafter surgery was1.1±0.6,0.5±0.3, B group from preoperative5.7±1.6,3±0.8to24months after surgery was1.4±0.8,1±0.5, significantly than that before operation (p<0.05).Group A ODI score from preoperative52.6±7.3to6、24months after operation,17.1±4.5,12.2±2.7, improved significantly (p<0.05) and better than group B (p<0.05). Group Asurgical segment ISR have no difference with preoperative in postoperative. After24months,A group surgery segment activity is54.3%of preoperative (p<0.05). After24months, adjacent segment activities in group A and B were increased compared withpreoperative results，but had no significant.Adjacent ISR had no significant comperedpreoperative.A group total lumbar activity is greater than B group after24months(p<0.05).2. Group C were followed up for24.5±4.7months,whose average age was53.6years old; Group D average age was67.2years old and were followed up for26.5±5.3months. C group of low back and leg pain scores from preoperative5.2±1.2,2.7±0.9to24months after surgery was1.2±0.8,0.4±0.2, D group from preoperative6.1±1.5,2.8±0.7to24months after surgery was1.4±0.7,0.8±0.6,were improved significantly (p<0.05),Cgroup was better than D group;Group C were54.4±9.4,dropped to6，24months afteroperation,19.2±3.4,12±3, at each time point of ODI scores were better than group D(p<0.05). Postoperation24months, ISR of surgical segments in group C descends15.6%compared preoperative(p<0.05). After24months,C group surgery segment activity is57.7%of preoperative (p<0.05). After24months, the two groups of the cranial adjacentsegment activity had increased compared with preoperative, the ISR’got nothingchanged(p>0.05). C group total lumbar activity is greater than D group after24months(p<0.05)Conclusion:1. Multisegments Dynesys non-fusion for mul-DDD get better clinical efficacy thanlumbar fusion;2. Dynesys systems retained segment motor function and little effection of total lumaractivity; 3. Dynesys had no significant effect on the adjacent segment, butalso need long-termobservation;4.Postoperative complications of Dynesys are fewer lumbar fusion.