Adjacent segment mobility after rigid and semirigid instrumentation of the lumbar spine.
METHODS
Retrospective radiographic analysis of lumbar spine range of motion (ROM) after monosegmental fusion and posterior dynamic stabilization at the level L4-L5.


OBJECTIVE
Comparison of segmental ROM at the index level and the cranial and caudal adjacent levels and of global lumbar spine ROM after monosegmental fusion and posterior dynamic stabilization.


BACKGROUND
The postulated advantage of nonfusion technology compared with fusion is based on the assumption that preservation of motion at the treated segment reduces the incidence of adjacent segment effects. Therefore, it is imperative to provide evidence that dynamic stabilization devices avoid hypermobility at the adjacent segments because this might substantiate a protective effect on the adjacent segments.


METHODS
Twenty-six patients with low back pain and claudication due to degenerative instability at the level L4-L5 with concomitant spinal stenosis were treated either with decompression and Dynesys (n = 11) or with decompression and fusion (n = 15). All patients underwent flexion/extension radiographs before surgery and at latest follow-up. ROM was assessed at the index level (L4-L5), the cranial/caudal adjacent levels (L3-L4/L5-S1), and at the lumbar spine from L2 to S1.


RESULTS
There was a significant reduction of the global ROM of the lumbar spine (L2-S1) and the segmental ROM at the index level (L4-L5) in the fusion group, whereas adjacent level ROM did not change significantly. In the Dynesys group, no significant changes of global lumbar spine ROM (L2-S1) and segmental ROM (index level and cranial/caudal adjacent levels) were seen.


CONCLUSIONS
This study shows that neither monosegmental instrumented fusion nor monosegmental posterior dynamic stabilization with Dynesys alter the ROM of the cranial and caudal adjacent levels. Consequently, monosegmental posterior dynamic stabilization with Dynesys has no effect with regard to adjacent segment mobility compared with monosegmental fusion.
Cakir
Balkan
B
Department of Orthopaedic Surgery, University of Ulm, Ulm, Germany. balkan.cakir@rku.de
Carazzo
Charles
C
Schmidt
René
R
Mattes
Thomas
T
Reichel
Heiko
H
Käfer
Wolfram
W
D000203:Activities of Daily Living; D000368:Aged; D001696:Biomechanical Phenomena; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D016268:Internal Fixators / Q000009:adverse effects*; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000601:surgery; D008159:Lumbar Vertebrae / Q000033:anatomy & histology / Q000502:physiology / Q000601:surgery*; D008297:Male; D008422:Materials Testing / Q000295:instrumentation; D008875:Middle Aged; D009068:Movement; D017063:Outcome Assessment, Health Care / Q000379:methods; D017060:Patient Satisfaction; D018583:Pliability; D011183:Postoperative Complications / Q000209:etiology / Q000473:pathology / Q000503:physiopathology*; D011187:Posture; D011474:Prosthesis Design / Q000295:instrumentation; D011475:Prosthesis Failure; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology*; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D013130:Spinal Stenosis / Q000601:surgery; D013314:Stress, Mechanical; D016896:Treatment Outcome; D016474:Weight-Bearing