| BACKGROUNDThe spinal fusion is used extensively in the treatment of the degenerative disc disease. Though the rate of successful fusion has increased,it has failed to reflect a comparable increase in the successful clinical outcome. And increasing evidence indicate, after fusion, change of biomechanical environment, restriction of lumbar movement, accelerated degeneration of the adjacent segments may cause new symptoms. It is reasonable to conclude that stopping movement is not the factor in treating degenerative disc disease.The ideal fixation should guarantee the spinal stabilization and recover the range of motion to the largest extent. On these background, non - fusion technology has emerged as a new technology of fixation. It can reserve the integrated function of intervertebral disc and zygapophysial joint, maintain the segmental movement to a normal level, and have no adverse effect on the adjacent segments. Non-fusion internal fixation have been used clinically as a surgery method for treating degenerative disc disease, but its application requires a reasonable and perfect verification. The implants'safety and long-term follow-up data need further clinical researches for the satisfactory outcomes.OBJECTIVETo compare the short-term clinical outcome of using posterior lumbar inter-body fusion and Wallis system treatment in patients with degenerative disc disease ,and to evaluate their influence on adjacent segmentsMETHODSThirty-seven cases of degenerative disc disease at L4～5 level were treated with posterior lumbar inter-body fusion (group PLIF) and Wallis system (group Wallis) from October 2008 to September 2010,and followed up for over one year . Observe the time of total operation and implantation, the bleeding, and the early clinical outcomes.Visual analogue scale (VAS) and Japanese Orthopedic Association (JOA) scores for low back pain and Oswestry disability index (ODI) were used to evaluate clinical outcomes. In addition, the range of motion (ROM) and posterior disc height (PDH) of the L4/5 level were also recorded to assess the biomechanical change before and after operationRESULTSGroup PLIF:the mean operation time was about 128 min and mean volume of blood loss 364 ml. Group Wallis:the mean operation time was about 80 min and mean volume of blood loss 120ml.The operation time and blood loss had a significant difference between group PLIF and group Wallis (P<0.01). In group PLIF,VAS decreased from 7.4±1.4 pre-operatively to 2.6±0.8 at 1 year post-operation, JOA improved from 19.1±1.6 to 26.1±1.1,OD I from 40.1±6.9 to 21.9±3.7. In Group Wallis,VAS decreased from 7.9±1.8 pre-operatively to 2.7±0.8 at 1 year post-operation , JOA improved from17.6±2.1 to 27.3±0.7,ODI from 43.7±9.2 to 20.7±4.1. No significant difference of clinical effect was found between Group Wallis and Group PLIF .In Group Wallis ,the PDH of L4/5 was significant elevated in 3 months post-operatively (P<0.05), but had no statically difference at 1 year post-operation when comparing to that of pre-operative level.The ROM of L4/5 level was significantly reduced from pre-operation to 1year post-operation (P<0.05). In Group PLIF the ROM of L3/4 level improved significantly (p< 0.01).CONCLUSION1.Both posterior lumbar inter-body fusion and Wallis system fixation have satisfying short-term clinical effects in treatment of degenerative lumbar spinal disorder.2.Wallis system has less influence on ROM of operated lumbar segments and could prevent the degeneration of adjacent segment.3.The Wallis system , as a non-fusion fixation technique , can preserve the mobility , anatomy and stability of operated lumbar vertebral bodies , promote the recover of the lesion discs.4.The preliminary clinical results show the Wallis system is a safe and effective new technique in treatment of lumbar disc degenerative disease. |
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