513 - Does Hybrid Fixation Prevent Junctional Disease after Posterior Fusion...

#513 Does Hybrid Fixation Prevent Junctional Disease after Posterior Fusion for Degenerative Lumbar Disease?

Posterior Dynamic Pedicular Stabilization

Poster Presented by: M. Di Silvestre


M. Di Silvestre (1)
T. Greggi (1)
A. Baioni (1)
F. Lolli (1)
F. Vommaro (1)
E. Maredi (1)
K. Martikos (1)
S. Giacomini (1)

(1) Rizzoli Orthopedic Institute, Spine Surgery Department, Bologna, Italy


Introduction: Posterior lumbar fixation with hybrid systems were introduced to reduce the incidence of junctional disease, often observed after posterior fusion augmented by rigid instrumentation for the treatment of degenerative disc disease.

Objectives: Medium- to long-term retrospective evaluation of clinical and radiographic outcome in the treatment of degenerative lumbar disease with hybrid posterior fixation.

Methods: A retrospective review was performed of all patients who underwent posterior lumbar instrumentation using hybrid fixation with the Dynesys Transition Option (DTO) for degenerative lumbar disease at our Spine Surgery Division between 2007 and 2011. This study included 30patients (18 women and 12 men) with a meanage of 51.2 (range, 27 to 73) years. In 13patients a laminectomy of one or more levels was also performed associated in 2 cases with discectomy, and in 7 cases with a foraminotomy. At the time of surgery, all patients had low back pain and/or sciatica (associated with claudication in 4 cases), due to unstable stenosis in 13 cases, to degenerative or isthmic spondylolisthesis (Meyerding grade I or II) in 6 cases, to lumbar degenerative scoliosis in 5 cases, to degenerative disc disease (DDD) of one or more adjacent levels in 6 cases. All patients were assessed by X-Ray images before and after surgery and at final follow-up in which was also investigated the possible development of junctional disease through X-Ray images in maximum flexion and extension. Clinical outcome was evaluated by comparing the Oswestry Disability Index (ODI), Roland and Morris Disability Questionnaire (RMDQ), and the visual analog scale (VAS) pain scores before surgery, after surgery and at final follow-up.

Results: At a mean follow-up of 41.9 (range, 27 to 66) months, we observed on X-Rays images 1 case of junctional disc disease (3.3%), which led to surgical revision after 18 months because of persistent crural pain: proximal extension of the dynamic part to T11 and distal extension of the rigid part to S1 was performed. In another case, a deep infection of the surgical wound two months after surgery was treated by surgical debridment, washing and drainage. The mean preoperative ODI score was 67.6, RMQD score was 15.1, VAS back pain score was 9.5, VAS leg pain score was 8.6. Postoperatively, these values improved to 28.1, 5.4, 3.1, and 2.9, respectively, and remained substantially unchanged at final follow-up: (27.7, 5.2, 2.9, and 2.7, respectively).

Conclusions: Hybrid posterior fixation of the lumbar spine in the treatment of degenerative lumbar disease provided a "protective" effect against junctional disease, and achieved good clinical outcomes.