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The surgical treatment of the lumbar disc prolapse: nucleotomy with additional transpedicular dynamic stabilization
Michael Putzier1, Sascha V Schneider, Julia F Funk
1Department of Orthopaedics, Center for Muskuloskeletal Surgery, Charité - University Medicine Berlin, Germany. michael.putzier@charite.de
Study Design:
Clinical and radiologic study evaluating the outcome after nucleotomy with dynamic stabilization compared with nucleotomy alone.
Objectives:
To investigate the effect of dynamic stabilization on the progression of segmental degeneration after nucleotomy.
Summary Of Background Data:
Nucleotomy as treatment for lumbar disc prolapse in combination with initial segment degeneration may lead to segmental instability. Dynamic stabilization systems restrict segmental motion and thus prevent further degeneration of the lumbar spine. They are designed to avoid the disadvantages of rigid fixation, such as pseudarthrosis and adjacent segment degeneration.
Methods:
Eighty-four patients underwent nucleotomy of the lumbar spine for the treatment of symptomatic disc prolapse. Additional dynamic stabilization (DYNESYS) was performed in 35 of those cases. All patients showed signs of initial disc degeneration (MODIC I). They underwent evaluation before surgery, 3 months after surgery, and at follow-up. The mean duration of follow-up was 34 months. Examinations included radiographs, magnetic resonance imaging (MRI), physical examination, and subjective patient evaluation using Oswestry score and visual analog scale (VAS).
Results:
Clinical symptoms, Oswestry score, and VAS improved significantly in both groups after 3 months. At follow-up, a significant increase in the Oswestry score and in the VAS was seen only in the nonstabilized group. In the dynamically stabilized group, no progression of disc degeneration was noted at follow-up, whereas radiologic signs of accelerated segmental degeneration existed in the solely nucleotomized group. There were no implant-associated complications.
Conclusions:
The applied dynamic stabilization system is useful to prevent progression of initial degenerative disc disease of lumbar spinal segments after nucleotomy.
