Comparisons Of Dynesys System And Posterior Lumbar Interbody Fusion In The Treatment Of Lumbar Disc Herniation

Objective: This study is to explore the recent clinical efficacies between Dynesys dynamic internal fixation system and posterior lumbar interbody fusion in the treatment of Lumbar disc herniation.Methods: 70 patients with lumbar intervertebral disc herniation(Lumbar intervertebral disc 4/5)were selected from September 2014 to March 2016 in Affiliated Hospital of Traditional Chinese Medicine of Southwest Medical University.35 patients were treated with Dynesys dynamic fixation system,and other patients were treated with posterior lumbar interbody fusion.The operation time,bleeding,hospitalization time,cost and complication index were recorded,and visual analogue scale(VAS),Oswestry disability index(ODI),Japanese Orthopedic Association score(JOA)were selected to evaluate the therapeutic effect of patients in two groups.Preoperation and after surgery in 1 week,1 month,3 month,6month and 12 month.All score were recorded by one professional doctor.In addition,the lumbar spinal motion before and after operation were measured with imaging methods,including the operative and adjacent segments.At the same time,the change height of intervertebral space of operative and adjacent segments were measured in 1 month,3 month,and6 month after operation.The patients were examined with X-ray film of lumbar lateral position,12 months after surgery,the patients were examined for the X-ray film of lumbar lateral position and dynamic X-ray film,Then analysing the data using SPSS 20.0 software.Results:(1)Dynesys group were significantly less than the fusion group in the operation time,bleeding,and there were significant difference in two groups(P<0.05);there was no significant difference in the hospitalization time in two groups(P>0.05);Dynesys group was significantly higher than fusion group in cost of hospitalization(P<0.05);(2)The VAS score,ODI score and JOA score of the patients in two groups were significantly improved at the end of 1 week,1 month,3month,6 month,12 month after operation and there was significant difference(P<0.05);in the same period time,there was no significant difference between two groups in VAS score,ODI score and JOA score(P>0.05);(3)In 12 month after operation,the range motion of surgical segment(lumbar4/5)decreased significantly in Dynesys group and there was significant difference(P<0.05);compared with preoperation,there was no significant difference in range motion of adjacent segments(lumbar3/4,lumbar 5 sacral 1)(P>0.05);12 months after operation,surgical segment(lumbar 4/5)had bony fusion in fusion group,and there was no range motion.The range motion of adjacent segments(lumbar 3/4,lumbar 5 sacral 1)was significantly increased(P<0.05).compared range motion of adjacent segments between two groups,Dynesys group is less than fusion group and there was significant difference(P<0.05).(4)In 12 months after operation,the operation section of intervertebral space ratio in two groups patients were significantly improved when compared with before operation(P<0.05),but there was no significant difference between two groups(P>0.05);In 12 months after the operation,intervertebral space ratio of adjacent segments(lumbar 3/4,lumbar 5/sacral 1)of two groups patients were lower when compard with preoperation(P<0.05);However,when compared with preoperation,there was no significant difference in Dynesys group(P>0.05)and there was significant difference in fusion group(P<0.05).The intervertebral space ratio of adjacent segments in Dynesys group were better than fusion group,and there was significant difference(P<0.05)。(5)1 patient got a dural laceration in group Dynesys,which were repaired,but cerebrospinal fluid leakage occurred after operation and this patient was healed after treated with incision decompression,adequate fluid replacement,and prevention of infection.1 patient got recurrent low back pain.There were 3 cases in fusion group who got recurrent low back pain,one patient got nerve root injury,and the internal fixation screw loosening in 1 cases.The complication rate of Dynesys group was 5.71%,which was better than fusion group(14.28%).Conclusion: Dynesys dynamic fixation and posterior lumbar fusion can play a good role in reducing pain,modifying function and releasing clinical symptoms in the treatment of lumbar disc herniation.The curative effect of two kinds of methods were equal to some existent.But the former has shorter operation time,less bleeding,fewer complications.In addition,it can retain part of the activities of surgery segments.And it has little effect on the activity of adjacent segments.The latter will make the surgical segment mobility loss,adjacent segment mobility will compensatory increases.They both can increase the height of the intervertebral space and cause the loss of the intervertebral space height of the adjacent segment,but the former intervertebral space height loss was significantly less than the latter;the former cost is relatively high and it will bring some economic pressure for patients.