Clinical And Radiographic Analysis Of Posterior Lumbar Spine Hybrid Surgery For The Treatment Of Lumbar Degenerative Disease

Objective:To evaluate the early clinical therapeutic effect of hybrid surgery fixation in lumbar degenerative disease, analyze the impaction on mobility of dynamic fixation, and discuss preliminary intervertebral disc rehydration after dynamic fixation by magnetic resonance imaging(MRI)technology.Methods:Sixty-five cases with lumbar degenerative disease who received operation in Department of Spinal Surgery of First Affiliated Hospital of Nanhua University between October 2011 and November 2014 were reviewed retrospectively. These cases were divided into two groups according to the operation method : group Isobar comprised 18 males and12 females( average age, 45.6 years) who had received hybrid surgery fixation, and group PLIF comprised 22 males and 13 females( average age, 45.6years) who had undergone posterior lumbar interbody fusion.The clinical effects were evaluated by visual analogue scale(VAS) scores,the Oswestrydisability index(ODI). Lumbar lordosis angle,global lumbar spine range of motion(ROM), ROM of 1st adjacent above segment(ROM1),1st adjacent caudal( ROM2), intervertebral space ratio(ISR) of index level(the level dynamically stabilized by Isobar) in group hybrid surgery and adjacent level in group PLIF. Apparent diffusion coefficient was assessed by lumbar MRI diffusion-weighted images(DWI).Results:Sixty-five cases were evaluated with a mean follow-up of 25.81 months. All the patients received X-ray re-check and 25 cases of group hybrid surgery received MRI re-check.At the last follow-up, the VAS scores of back and leg pain and ODI scores of two groups were improved significantly(P < 0.01)than those of pre-operation. There was no significant difference between two groups(P>0.05).ISR of index level was not significant difference between preoperatively and final follow-up in group hybrid surgery(P>0.05).The flexion-extension ROM of the operated segment in group hybrid surgery was significantly different(P<0.01),and it has no significant change at the adjacent level and total lumbar segments(P>0.05). However, the ROM of the upper adjacent level in group PLIF, which was significantly increased(P<0.05), and it has no statistically significant difference at the lower adjacent segment and total lumbar segments(P>0.05). In group hybrid surgery, 30 cases received lumbar MRI reexamination. Their average ADC values were significantly improved at the last follow-up postoperatively(P<0.05).Conclusion : Hybrid surgery fixation through has some advantages of minimal invasiveness, safety and effective; hybrid surgery fixation is able to reserve segmental ROM of the stabilized segments and avoid hypermobility at the adjacent segments. Meanwhile, intervertebral disc rehydration emerges, suggesting that dynamic fixation contributes to disc tissue repair.