2010, Number 6
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ABSTRACTBackground: Semirigid posterior stabilization is an alternative, avoiding arthrodesis in operated segments. However, this results in the need for dynamic stabilization to allow a stable feature function.
Methods: We conducted a prospective longitudinal self-reported interventional study. We included 46 patients with dynamic Dallostype interspinous stabilization between 1997 and 2004. A 4-year follow-up analysis was performed using clinical and radiographic studies, preoperatively and 4 years later evaluating lumbar disability, pain, disc height, disc angle (neutral, flexion, and extension). Descriptive statistics were used along with Wilcoxon signed range test. Statistical significance was accepted when p ‹0.05.
Results: Of 46 patients, 39 completed a 4-year follow-up. Included in the study were nine females and 30 males with an average age of 30.74 years. Affected levels were L4 and L5 (21 patients); L5/S1 (17 patients) and L3/L4 (one patient). An improvement was reported of 80.3% according to the Oswestry scale (p = 0.0001). Preoperative pain decreased 6.8 points VAS. Disc height decreased 0.1 mm on average without significance. Disc angle (neutral) increased 1.13 ° without statistical difference. For flexion the increase was 2.641 ° (p = 0.0002), and extension decreased 0.817 ° on average without statistical significance. Range of mobility decreased 3.416 ° (p = 0.004).
Conclusions: Interspinous ligamentoplasty improves segmental stability, allowing mobility within normal ranges and preserving disc height at 4 years of follow-up, as well as offering greater dynamic stability. Successful clinical improvement was demonstrated.
White AA, Padjabi MM. The basic kinematics of the human spine. A review of past and current knowledge. Spine 1978;3:12-20.
Kirkaldy-Willis WH, Farfan HF. Instability of the lumbar spine. Clin Orthop 1982;165:110-123.
Luque ER, Rapp GF. A new semirigid method for interpedicular fixation of the spine. Orthopedics 1988;11:1945-1950.
Hayes MA, Howard TC, Gruel CR, Kopta JA. Roentgenografic evaluation of lumbar spine flexion-extension in asymptomatic individuals. Spine 1989;3:103-113.
Senegas J. Surgery of the intervertebral ligaments, alternative to arthrodesis in the treatment of degenerative instabilities. Acta Ortop Belg 1991;57(suppl 1):221-226.
Graf H. Lumbar instability: surgical treatment without fusion. Rachis 1992;412:123-137.
Strauss PJ, Novotny JE, Wilder DG, Grobler LJ, Pope MH. Multidirectional stability of the Graf system. Spine 1994;19:965-972.
Hadlow SV, Fagan AB, Hillier TM, Fraser RD. The Graf ligamentoplasty procedure. Comparison with posterolateral fusion in the management of low back pain. Spine 1998;23:1172-1179.
Reyes A, Villanueva P, Miramontes V. Ligamentoplastia interespinosa lumbar con corion para el tratamiento de inestabilidad vertebral. Rev Mex Ortop Traum 1998;12:564-567.
Fujiwara A, Lim TH, An HS, Tanaka N, Jeon CH, Andersson GB. The effect of disc degeneration and facet joint osteoarthritis on the segmental flexibility of the lumbar spine. Spine 2000;25:3036-3044.
Rigby MC, Selmon GP, Foy MA, Fogg AJ. Graf ligament stabilization: mid- to long-term follow-up. Eur Spine J 2001;10:234-236.
Hashimoto T, Oha F, Shigenobu K, Kanayama M, Harada M, Ohkoshi Y, et al. Mid-term clinical results of Graf stabilization for lumbar degenerative pathologies: a minimim 2-year follow-up. Spine J 2001;1:283-289.
Senegas J. Mechanical supplementation by non-rigid fixation in degenerative intervertebral lumbar segments: The Wallis System. Eur Spine J 2002;2:S164-169.
Gradner A, Pande KC. Graf ligamentoplasty: a 7 year follow-up. Eur Spine J 2002;11:157-163.
Stoll TM, Dubois G, Schwarzenbach O. The dynamic neutralization system for the spine: a multicenter study of a novel nonfusion system. Eur Spine J 2002;11(suppl 2):S170-S178.
Phillips FM, Reuben J, Wetzel FT. Intervertebral disc degeneration adjacent to a lumbar fusion, an experimental rabbit model. J Bone Joint Surg Br 2002;84:289-294.
Markwalder M, Wenger M. Dynamic stabilization of lumbar motion segments by use of Graf´s ligaments: results with an average follow-up of 7.4 years in 39 highly selected, consecutive patients. Acta Neurochir 2003;145:209-214.
Akamaru T, Kawahara N, Tim Yoon S, Minamide A, Su Kim K, Tomita K. Adjacent segment motion after a simulated lumbar fusion in different sagittal alignments: a biomechanical analysis. Spine 2003;28:1560-1566.
Korovessis P, Papazisis Z, Koureas G, Lambiris E. Rigid, semirigid versus dynamic instrumentation for degenerative lumbar spinal stenosis. Spine 2004;29:733-742.
Nockels R. Dynamic stabilization in the surgical management of painful lumbar spinal disorders. Spine 2005;30:568-572.
Grob D, Benini A, Junge A, Mannion AF. Clinical experience with the dynesys semirigid fixation system for the lumbar spine surgical and patient-oriented outcome in 50 cases after an average of 2 years. Spine 2005;30:324-331.
Kanayama M, Hashimoto T, Shigenobu K, Oha F, Ishida T, Yamane S. Non-fusion surgery for degenerative spondylolisthesis using artificial ligament stabilization. Spine 2005;30:588-592.
Kanayama M, Hashimoto T, Shigenobu K. Rationale, biomechanics, and surgical indications for Graf ligamentoplasty. Orthop Clin North Am 2005;36:373-377.
Schwarzenbach O, Berlemann U, Stoll TM, Dubois G. Posterior dynamic stabilization systems: DYNESYS. Orthop Clin North Am 2005;36:363-372.
Grob D, Benini A, Junge A, Mannion AF. Clinical experience with the Dynesys semirigid fixation system for the lumbar spine: surgical and patient-oriented outcome in 50 cases after an average of 2 years. Spine 2005;30:324-331.
Schnake KJ, Schaeren S, Jeanneret B. Dynamic stabilization in addition to decompression for lumbar spinal stenosis with degenerative spondylolisthesis. Spine 2006;31:442-449.
Wilke HJ, Schmidt H, Werner K, Schmölz W, Drumm J. Biomechanical evaluation of a new total posterior-element replacement system. Spine 2006;31:2790-2796.
Beastall J, Karadimas E, Siddiqui M, Nicol M, Hughes J, Smith F. The Dynesys lumbar spinal stabilization system. A preliminary report on positional magnetic resonance imaging findings. Spine 2007;32:685-690.
Mulholland RC, Sengupta DK. Rationale, principles and experimental evaluation of the concept of soft stabilization. Eur Spine J 2007;11(suppl 2):S198-S205.
Huang RC, Wright TM, Panjabi MM, Lipman JD. Biomechanics of nonfusion implants. Orthop Clin North Am 2005;36:271-280.
Sengupta DK, Mulholland RC. Fulcrum assisted soft stabilization system: a new concept in the surgical treatment of degenerative low back pain. Spine 2005;30:1019-1029.
Schmoelz W, Huber JF, Nydegger T. Influence of a dynamic stabilization system on load bearing of a bridged disc: an in vitro study of intradiscal pressure. Eur Spine J 2006;15:1276-1285.
Kondrashov DG, Hannibal M, Hsu KY, Zucherman JF. Interspinous process decompression with the X-STOP device for lumbar spinal stenosis: a 4-year follow-up study. J Spinal Disord Tech 2006;19:323-327.
Anderson PA, Tribus CB, Kitchel SH. Treatment of neurogenic claudication by interspinous decompression: application of the X STOP device in patients with lumbar degenerative spondylolisthesis. J Neurosurg Spine 2006;4:463-471.
Molinari RW. Dynamic stabilization of the lumbar spine. Curr Opin Orthop 2007;18:215-220.
Senegas J, Vital JM. Long-term actuarial survivorship analysis of an interspinous stabilization system. Eur Spine J 2007;16:1989-1990.
Rosales L, Pérez A, Miramontes V, Alpízar A, Reyes A. Experiencia en México con prótesis discal de núcleo. Reporte final a 4 años de seguimiento. Cir Cir 2007;75:31-36.
Taylor J, Pupin P, Delajoux S, Palmer S. Device for intervertebral assisted motion: technique and initial results. Neurosug Focus 2007;22:E6-E10