Comparisons Of Dynesys Stabilization And Posterior Lumbar Interbody Fusion For L_4-5 Single-segment Lumbar Degenerative Disease

Objective:To assess the semeiologic and imaging outcomes between Dynesys fixation and posterior lumbar interbody fusion(PLIF) in the therapy of lumbar degenerative disease(L4-5).So could supply a theoretic help in future work.Method:76 patients of lumbar spine degenerative trouble were cured with either Dynesys or PLIF between July 2008 and July 2012, 35 patients underwent Dynesys procedure and 41 underwent PLIF. The preoperative and final clinical outcome was evaluated by VAS score and ODI score.The extension- flexion rang and the intervertebral height of the observed segments was surveyed from X-rays. The change of the up and down adjacent disc signal was weighed from MRI, and the degeneration was classified in line with of the Pfirrmann grade,and measured it by image J.All outcomes of the up and down adjacent discs was assessed by UCLA.Results:None of the pedicle screw was failed and all segments in PLIF team was conjunction at the end.No complications related to the operation and no neurologic deterioration occured in the two groups. Also there are no patientsn died during perioperative period.The statistical differences of cases’ sex, disease types, age, up and down disc Pfirrmann grading.Preoperative ODI and VAS score within them was not remarkable diffierent(Table2-1),and both decreased remarkable in the two groups at the end(Table 2-1), but the changes between them were not remarkable(Table 2-1). The difference of intervertebralheight in the two groups was not significant before operaion. There was no obvious changes in the Dynesys group at the final follow-up,but the PLIF group gained a bigger increase(Table 2-2),and the increase between them were remarkable(Table 2-2).The differences of intervertebral height in up and down one in both groups was not remarkable(Table 2-2). The ROM of L3~4 in both groups increased remarkable(Table2-2),and the changes between them were remarkable at the end(Table 2-2). The ROM of distal adjacent segments in both groups increased significantly(Table 2-2) at the final follow-up,but no remarkable difference in intergroup(Table 2-2).The dics Pfirrmann grade changes in interior-group were obvious(Table 2-5),and only the difference of the proximal one in intergroup was remarkable(Table 2-5).Not only the acreage and the signal strength in two groups decreased remarkably,but also the MRI index decreased remarkably(Table2-6) at the end, though the intergroup difference was not remarkable(Table2-7).Degenerative segments were found in both group(Dynesys group 8/70;PLIF group22/82),on the base of UCLA grade.The intergroup difference was remarkable(Table1-1).Only 1 case in PLIF group had symptomatic adjacent segment degeneration, and accepted another operation.Conclusion:Both Dynesys and PLIF are reliable for lumbar degenerative disease. Dynesys stabilization has less influence on the ROM of cranial adjacent segments, and thererfor less risks in developing ASD.