Use The Step Pretreatment Quantitative Score Table Of Adjacent Segment Before Fusion To Assess Posterior Dynamic Stabilization And Posterior Lumbar Interbody Fusion For The Treatment Of Single-segment Lumbar Degenerative Disease

Objective : Firstly use the quantitative score table of adjacent segment to compare the radiological outcomes between posterior dynamic stabilization and posterior lumbar interbody fusion for the treatment of single-segment lumbar degenerative disease.To assess protective effect of dynamic stabilization in preventing adjacent segment degeneration.Method: A total of 85 patients with single-segment lumbar degenerative disease were enrolled between July 2008 and July 2012 according to the inclusion criteria.Of these,39 patients underwent dynamic stabilization and 46 patients underwent PLIF.To compare the operative duration and blood loss,and to evaluate the clinical outcome,including visual analogue scale(VAS) and Oswestry disability index(ODI),and radiological outcome of adjacent cranial segment,including quantitative score results and Pfirrmann classification,Weishaup classification,Modic changes,High- intensity zone and segmental instabilityResults: All patients received complete follow- up.None of the pedicle screw was failed and all segments in PLIF group got complete conjunction at end.N o complications related to the operation and no neurologic deterioration occured in the two groups. Also there were no patients died during perioperative period.The differences of patients’ sex and disease types was not significant.The VAS and ODI scores improved significantly in both groups at the final follow- up(P<0.05),but the difference between two groups was not significant(P>0.05).The Preoperative quantitative scores between groups was significant;The differences between groups preoperatively at Pfirrmann classification,Weishaup classification,Modic changes,High- intensity zone and segmental instability was not significant.The Pfirrmann classification and Weishaup classification both aggravated significantly in PLIF group,the difference between groups was not significant.Sagittal translation over 4mm,no patients in Dynesys group,5patients in PLIF group,Sagittal segmental intervertebral motion over 10°,2patients in Dynesys group,and 9patients in PLIF group,in total,segmental instability occurred in 11 patients of PLIF group,and 2 patients in Dynesys group,with significant difference between groups.Modic ype 2 change in 2 patients of PLIF group converted to type 3 change,no changes in Dynesys group,with no significant difference between groups.4 patients occurred HIZ in PLIF group,and 2 patients in Dynesys group, with no significant difference between groups..In total,there were 25 patients of radiographic ASD in PLIF group,and 6 patients in Dynesys group,with significant difference between groups.Only 1 patient in PLIF group received a second operation due to symptomatic adjacent segment degeneration.Conclusion: Posterior dynamic stabilization or posterior lumbar interbody fusion has equal clinical results for the treatment of single-segment lumbar degenerative disease,but dynamic stabilization has lower incidence of ASD.