Long-term Outcome of Posterolateral Fusion with Dynamic Transpedicular Topping-off for the AdultDegenerative Lumbar Spine. Report of 30 cases with more than 9-year follow-up
Felipe Garibo1, José Ignacio Maruenda1, Borja Maruenda2, Carlos Barrios3
1University Clinic Hospital, Valencia, Spain; 2Hopsital de la Ribera, Alzira, Spain; 3Valencia Catholic University, Valencia, Spain
Corresponding author: [email protected]
Background/Introduction: It is speculated that hybrid one-level or multi-level fusion constructs with dynamic topping-off stabilization could reduce the incidence of adjacent segment degeneration (ASD), but there are currently no long-term data.
Purpose of the study: This study analyzes the 9-year follow-up outcomes of this type of hybrid systems, with special emphasis on the adjacent disc radiological degeneration and the rate of reintervention.
Material and Methods
Study design: retrospective review• 30 patients with lumbar degenerative
disease (17 F, 13 M) • mean age, 49 years (range 21-68)
Patients underwent posterior Fusion (1 to 4 levels) with dynamic topping-of stabilization (hybrid construct) using a transpedicular device (TTL®)
Primary surgery, 24 patientsRevision surgery, 6 patients (Adjacent segment disease)
TTLDevice
Clinical outcomes were assessed with: Lumbar and radicular VAS, Oswestry disability index (ODI) and degree of patient satisfaction.
Changes in adjacent discs were assessed using conventional radiographs (UCLA scale) and MRI (Pfirmann).
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Results
SurgeryMean duration of surgery: 194 min. (175-270)Mean blood los: 850 ml (400-1200)Mean hospital discharge: 7 days (5-30)
Operative complicationsIntraoperative: 0Inmediate Postop: 5 (16.6%)
Transient radiculopathy, 3Seroma, 1Hematoma, 1
Results
A significant initial postoperative clinical improvement was found: lumbar and radicular VAS passed from 6.8 and 5.6 before surgery to 3.2 and 2.8 respectively at immediate postoperative evaluation;
ODI decrease from 59.9 preop to 29.1 at the postoperative period.
A 80% of patients were satisfied with the procedure in the immediate postoperative period.
At 9-years follow-up, worsening of the clinical parameters was found: mean lumbar and radicular VAS were 4.5 and 4.3, and ODI increased to 39.3. The patient satisfaction rate decrease to 60%.
Adjacent segment radiographic changes (loss of disc height) were found in 2 cases (6.6%) that also showed a progression of disc degeneration on MRI (Pfirrmann grade 3 to 4).
Osteolysis around the topping-off screws was detected in other 2 cases (6.6%).
Revision surgery was required in 3 cases (9.9%): - one with screw loosening - 2 with discitis of adjacent upper segment.
There were no rod or screw breakages.
Author Years nRod/ScrewBreakage
Screwloosening ASD RevisionSurgery
Hudson2007 2 23 0 3(13%) 1(4,3%) 3(13%)
Perrin2008 8 23 0 0 0 0
Li2012 2 36 0 4(11%) 14(39%) 5(13,8%)
Gao2014 2 24 ND ND 3(12,5%) ND
Fu2014 2 36 ND ND ND ND
TotalPreviousSeries 3,2 142 0 7(8,5%) 18(14.7%) 8(9,7%)
ComplicationsrelatedtoTTLuse
ND:nodata
CurrentSeries2017
9 30 0 2(3,3%) 2(6,6%) 3(10%)
ReviewoftheLiterature
Conclusions
1. Long-term outcomes of posterior lumbar fusion with topping-off dynamic transpedicular stabilization show a low rate of ASD and revision surgery.
2. The re-operations were due to implant failures (lysis around the pedicle screw).
3. There were no rod or screw breakages.
Future perspectives: Although follow-up is relatively long, it seems still necessary further long term randomized studies to confirm the efficacy of hybrid constructs in preventing adjacent segment degeneration.
FelipeGaribo NothingtodisclosureJoséIgnacioMaruenda NothingtodisclosureCarlosBarrios NothingtodisclosureBorjaMaruenda Nothingtodisclosure
DisclosureInformation
