Study On The Application And Early Clinical Efficacy Of The Dynamic Stabilization System In The Lumbar Spine Degenerative Disease And Compared With Traditional Surgical Approach

PartⅠThe Dynamic Stabilization System in Addition to Decomprssion for the Degenrative Lumar Spinal Stenosis.Objective:To investigate the efficacy and safety of the dynamic stabilization system in addition to decompression for degenerative lumbar spinal stenosis.Methods From January 2007 to June 2008,23 consecutive patients (10 males and 13 females) with lumbar spinal stenosis underwent decompression and Dynesys dynamic stabilization. The age was 56.38±11.63 years (range 38-68 years). Results The follow-up period was 26.23±7.34 months (range 17-34 months). The VAS decreased from preoperative score of 8.16±0.98 (6-10) to postoperative score of 2.24±1.32 (0 to 5) (P =0.001), and the patients'Oswestry disability index was improved from preoperative score of 72.42±17.01 (45 to 89) to postoperative score of 22.43±14.67 (0to48) (P= 0.002). No patient had screw loosensing and screw breakage. According to clinical outcome judgement criterion of Macnab, excellent in 17cases, good 4 cases, fair 2 cases, the excellent and good rate was 91.3%. Conclusions It is concluded that early outcome were excellent when we used the Dynesys dynamic stabilization system in addition to decompression for degenerative lumbar spinal stenosis. It prevent the degeneration of the instrumented level and the adjacent segments. It is a nofusion and semirigid fixation for the lumbar degenarative diseases. Part IITO compare the early clinical results of the treatment of degenerative lumbar spinal stenosis with two different methods.Objective To compare the early clinical results of the treatment of degenerative lumbar spinal stenosis with the dynamic stabilization system in addition to decompression and fusion, fixation in addition to decompression. Methods We treated 87 patients with degenerative lumbar spinal stenosis, from January 2007 to January 2009. Patients with degenerative lumbar spinal stenosis were randomly assigned to be treated with dynamic stabilization system in addition to decompression (group A) and fusion, fixation in addition to decompression (group B). The group A consisted of twenty-eight patients, and the group B consisted of fifty-nine patients. The factors considered included the operative time, amount of intraoperative bleeding,pre and post operative assessment based on pain visual analog scales(VAS) and the Oswestry disability index(ODI), the total excellent and good ratio of outcome. Results All the patients were followed up for a mean of 26 months(range,13～37 months). The final valuation was based on the documents of the last fellow up. The two groups had significant differences on operative time, amount of intraoperative bleeding, the group B is higher than the group A(P<0.05). There were no significant differences in the pain visual analog scales(VAS) and the Oswestry disability index(ODI), the total excellent and good ratio of outcome(P>0.05). In the two group, VAS and the Oswestry disability index(ODI), improved from preoperative to postoperative(P<0.05). Conclusion Compared to the segment fusion and fixation, transpedicular dynamic stabilization for the treatment of degenerative lumbar spinal stenosis, have the merit of minimally invasive, shorter surgical time, little hemorrhage.But their early clinical effect were comparable, maintain the stabilization of the spine, prevent the degeneration of the instrumented segments and adjacent segments.Part IIITo compare the clinical results of the treatment of lumbar disc prolapse with the transpedicular dynamic stabilization in addition to nucleotomy and nucleotomy alone.Objective To compare the clinical results of the treatment of lumbar disc prolapse with the transpedicular dynamic stabilization in addition to nucleotomy and nucleotomy alone. Methods We treated lumbar disc prolapse with two different methods, from January 2007 to January 2009. Group A:the transpedicular dynamic stabilization in addition to nucleotomy. Group B:microsurgical nucleotomy alone. The group A consisted of twenty-six patients, all of them were followed up.The group B consisted of five hundreds and fifty-six patients, only 378 patients were followed up. The factors considered included the operative time, amount of intraoperative bleeding,pre and post operative assessment based on pain visual analog scales(VAS) and the Oswestry disability index(ODI), the total excellent and good ratio of outcome. Results All the patients were followed up for a mean of 28 months(range,13～37 months). The final valuation was based on the documents of the last fellow up. The two groups had significant differences on operative time, amount of intraoperative bleeding, the group A is higher than the group B(P<0.05). There were no significant differences in the pain visual analog scales(VAS) and the Oswestry disability index(ODI), the total excellent and good ratio of outcome(P>0.05). In the two group, VAS and the Oswestry disability index(ODI) improved from preoperative to postoperative(P<0.05). The were no reprolapse and instability in group A. Two reprolapse and two instability of spine were seen in group B. Conclusion Both the clinical effects of the two methods are satisfactory. Microsurgical nucleotomy alone have the merit of minimally invasive, shorter surgical time, little hemorrhage.However, the transpedicular dynamic stabilization in addition to nucleotomy maintain the stabilization of the spine, prevent the degeneration, reprolapse and instability of the instrumented and adjacent segments.