Interspinous dynamic stabilization adjacent to fusion versus double-segment fusion for treatment of lumbar degenerative disease with a minimum follow-up of three years.
The aim of this study was to assess the outcome of symptomatic lumbar degenerative disease treated with topping-off technique (Coflex(™) combined with fusion) and compare two-segment fusion at mid-long term follow-up; and find out whether the topping-off technique can reduce the rate of adjacent segment degeneration (ASD) after fusion.



One hundred and fifty-four consecutive patients who received topping-off surgery (76 patients) and two-segment fusion surgery (88 patients) from March 2009 to March 2012 were studied. All patients included in the analysis had a minimum of three years of follow-up. Radiographic and clinical outcomes between the two groups were compared. A logistic regression analysis was used to analyze risk factors for developing radiographic ASD.



Significant differences in clinical outcomes were observed between these two groups at three post-operative years (all, p < 0.05). Compared with the fusion group, the topping-off group showed preserved mobility at the Coflex(™) level (p = 0.000), which is associated with less blood loss (p = 0.000), shorter duration of surgery (p = 0.000) and lower incidence of ASD (Chi-square test, rate topping-off vs fusion = 13.2 vs 26.1 %, p = 0.039). There were no differences in complications between the two groups.



Mid-long term follow-up efficacy and safety between topping-off and fusion were similar, while topping-off reduced the rate of ASD. Under strict indications, topping-off surgery is an acceptable alternative to fusion surgery for the treatment of two-segment lumbar disease.
Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, 8# Gong ti south street, Chao-Yang district, Beijing, 100020, China.
Xiao-Long
XL
Chen
Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, 8# Gong ti south street, Chao-Yang district, Beijing, 100020, China.
Li
L
Guan
Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, 8# Gong ti south street, Chao-Yang district, Beijing, 100020, China.
Yu-Zeng
YZ
Liu
Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, 8# Gong ti south street, Chao-Yang district, Beijing, 100020, China.
Jin-Cai
JC
Yang
Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, 8# Gong ti south street, Chao-Yang district, Beijing, 100020, China.
Wen-Long
WL
Wang
Department of Orthopedics, Beijing Chao-Yang Hospital, Capital Medical University, 8# Gong ti south street, Chao-Yang district, Beijing, 100020, China. chensmalldragon@sohu.com.
Yong
Y
Hai
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008159:Lumbar Vertebrae / Q000601:surgery*; D008161:Lumbosacral Region; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011184:Postoperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
Adjacent segment; Coflex™; Dynamic fixation; Fusion; Lumbar