Dynamic Rod Constructs as the Preventive Strategy against Adjacent Segment Disease in Degenerative Lumbar Spinal Disorders: A Retrospective Comparative Cohort Study
Publish place: The Archives of Bone and Joint Surgery، Vol: 11، Issue: 6
Publish Year: 1402
نوع سند: مقاله ژورنالی
زبان: English
View: 131
This Paper With 10 Page And PDF Format Ready To Download
- Certificate
- من نویسنده این مقاله هستم
استخراج به نرم افزارهای پژوهشی:
شناسه ملی سند علمی:
JR_TABO-11-6_005
تاریخ نمایه سازی: 27 خرداد 1402
Abstract:
Objectives: Adjacent segment degeneration (ASDe) and adjacent segment disease (ASDi) are potential long-term complications after lumbar fusion with rigid instrumentation. Dynamic fixation techniques (Topping-off) adjacent to the fused segments have been developed to curtail the risk of ASDe and ASDi. The current study sought to investigate whether the addition of dynamic rod constructs (DRC) in patients with preoperative degeneration in the adjacent disc was effective in reducing the risk of ASDi. Methods: A retrospective analysis was performed on clinical data of ۲۰۷ patients with degenerative lumbar disorders (DLD) from January ۲۰۱۲ to January ۲۰۱۹, who underwent posterior transpedicular lumbar fusion (without Topping-off, NoT/O), and posterior dynamic instrumentation with DRC. Clinical and radiological outcomes were evaluated using Oswestry Disability Index (ODI), Visual Analogue Scale (VAS), and lumbar radiographs one, three, and ۱۲ months postoperatively and annually. ASDe was defined as disc height collapse > ۲۰% and disc wedging > ۵. Patients with confirmed ASDe and aggravation of ODI > ۲۰ or VAS score > ۵ at final follow-up were diagnosed as ASDi. The Kaplan-Meier hazard method was used to estimate the cumulative probability of ASDi within ۶۳ months of surgery. Results: Over three years of follow-up, ۶۵ patients in the NoT/O (۵۹.۶%) and ۵۲ cases (۵۳.۱%) in the DRC groups met the diagnostic criteria for ASDe. Furthermore, ۲۷ (۲۴.۸%) patients in the NoT/O group showed ASDi during the follow-up, compared to ۱۴ (۱۴.۳%) cases in the DRC group (P=۰.۰۵۹). Revision surgery was performed on ۱۹ individuals in the NoT/O and ۸ cases in the DRC groups (P=۰.۰۴۸). The Cox regression model identified a significantly decreased risk of ASDi if DRC was used (Hazard ratio: ۰.۲۹; ۹۵% CI: ۰.۱۳-۰.۶). Conclusion: Dynamic fixation adjacent to the fused segment is an effective strategy for preventing ASDi in carefully selected individuals with preoperative degenerative changes at the adjacent level. Level of evidence: II
Keywords:
Adjacent segment disease , Degenerative lumbar spinal disorders , Dynamic fixation , Lumbar instrumentation , Rigid Fixation
Authors
Sajjad Saghebdoust
Department of Neurosurgery, Razavi Hospital, Mashhad, Iran
Reza Zare
Department of Neurosurgery, Razavi Hospital, Mashhad, Iran
Bipin Chaurasia
Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal
Mohammad Moein Vakilzadeh
Cancer Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
Omid Yousefi
Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
Mohammad Reza Boustani
Department of Neurosurgery, Golestan Hospital, Tehran, Iran
مراجع و منابع این Paper:
لیست زیر مراجع و منابع استفاده شده در این Paper را نمایش می دهد. این مراجع به صورت کاملا ماشینی و بر اساس هوش مصنوعی استخراج شده اند و لذا ممکن است دارای اشکالاتی باشند که به مرور زمان دقت استخراج این محتوا افزایش می یابد. مراجعی که مقالات مربوط به آنها در سیویلیکا نمایه شده و پیدا شده اند، به خود Paper لینک شده اند :