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Original article
peer-reviewed

Evaluation of a Hybrid Dynamic Stabilization and Fusion System in the Lumbar Spine: A 10 Year Experience



Abstract

Introduction: The development of adjacent-segment disease is a recognized consequence of lumbar fusion surgery. Posterior dynamic stabilization, or motion preservation, techniques have been developed which theoretically decrease stress on adjacent segments following fusion. This study presents the experience of using a hybrid dynamic stabilization and fusion construct for degenerative lumbar spine pathology in place of rigid arthrodesis.

Methods: A clinical cohort investigation was conducted of 66 consecutive patients (31 female, 35 male; mean age: 53 years, range: 25 – 76 years) who underwent posterior lumbar instrumentation with the Dynesys Transition Optima (DTO) implant (Zimmer-Biomet Spine, Warsaw, IN) hybrid dynamic stabilization and fusion system over a 10-year period. The median length of follow-up was five years. DTO consists of pedicle screw fixation coupled to a rigid rod as well as a flexible longitudinal connecting system. All patients had symptoms of back pain and neurogenic claudication refractory to non-surgical treatment. Patients underwent lumbar arthrodesis surgery in which the hybrid system was used for stabilization instead of arthrodesis of the stenotic adjacent level.

Results: Indications for DTO instrumentation were primary degenerative disc disease (n = 52) and failed back surgery syndrome (n = 14). The most common dynamically stabilized and fused segments were L3-L4 (n = 37) and L5-S1 (n = 33), respectively. Thirty-eight patients (56%) underwent decompression at the dynamically stabilized level, and 57 patients (86%) had an interbody device placed at the level of arthrodesis. Complications during the follow-up period included a single case of screw breakage and a single case of pseudoarthrosis. Ten patients (15%) subsequently underwent conversion of the dynamic stabilization portion of their DTO instrumentation to rigid spinal arthrodesis.

Conclusion: The DTO system represents a novel hybrid dynamic stabilization and fusion construct. This 10-year experience found the device to be highly effective as well as safe. The technique may serve as an alternative to multilevel arthrodesis. Implantation of a motion-preserving dynamic stabilization device immediately adjacent to a fused level instead of extending a rigid construct may reduce the subsequent development of adjacent-segment disease in this patient population.



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Original article
peer-reviewed

Evaluation of a Hybrid Dynamic Stabilization and Fusion System in the Lumbar Spine: A 10 Year Experience


Author Information

Ahmed Kashkoush

Department of Neurological Surgery, University of Pittsburgh Medical Center

Nitin Agarwal

Department of Neurological Surgery, University of Pittsburgh Medical Center

Erin Paschel

Department of Neurological Surgery, University of Pittsburgh Medical Center

Ezequiel Goldschmidt

Department of Neurological Surgery, University of Pittsburgh Medical Center

Peter C. Gerszten Corresponding Author

Department of Neurological Surgery, University of Pittsburgh Medical Center


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Approval for the study was received from the University of Pittsburgh’s Institutional Review Board. issued approval PRO07060042. Animal subjects: This study did not involve animal subjects or tissue. Conflicts of interest: The authors have declared the following conflicts of interest: Financial relationships: Peter Gerszten declare(s) personal fees from Zimmer Spine. Consultant.


Original article
peer-reviewed

Evaluation of a Hybrid Dynamic Stabilization and Fusion System in the Lumbar Spine: A 10 Year Experience


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Original article
peer-reviewed

Evaluation of a Hybrid Dynamic Stabilization and Fusion System in the Lumbar Spine: A 10 Year Experience

  • Author Information
    Ahmed Kashkoush

    Department of Neurological Surgery, University of Pittsburgh Medical Center

    Nitin Agarwal

    Department of Neurological Surgery, University of Pittsburgh Medical Center

    Erin Paschel

    Department of Neurological Surgery, University of Pittsburgh Medical Center

    Ezequiel Goldschmidt

    Department of Neurological Surgery, University of Pittsburgh Medical Center

    Peter C. Gerszten Corresponding Author

    Department of Neurological Surgery, University of Pittsburgh Medical Center


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Approval for the study was received from the University of Pittsburgh’s Institutional Review Board. issued approval PRO07060042. Animal subjects: This study did not involve animal subjects or tissue. Conflicts of interest: The authors have declared the following conflicts of interest: Financial relationships: Peter Gerszten declare(s) personal fees from Zimmer Spine. Consultant.

    Acknowledgements


    Article Information

    Published: June 10, 2016

    DOI

    10.7759/cureus.637

    Cite this article as:

    Kashkoush A, Agarwal N, Paschel E, et al. (June 10, 2016) Evaluation of a Hybrid Dynamic Stabilization and Fusion System in the Lumbar Spine: A 10 Year Experience. Cureus 8(6): e637. doi:10.7759/cureus.637

    Publication history

    Received by Cureus: May 15, 2016
    Peer review began: May 17, 2016
    Peer review concluded: June 03, 2016
    Published: June 10, 2016

    Copyright

    © Copyright 2016
    Kashkoush et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Introduction: The development of adjacent-segment disease is a recognized consequence of lumbar fusion surgery. Posterior dynamic stabilization, or motion preservation, techniques have been developed which theoretically decrease stress on adjacent segments following fusion. This study presents the experience of using a hybrid dynamic stabilization and fusion construct for degenerative lumbar spine pathology in place of rigid arthrodesis.

Methods: A clinical cohort investigation was conducted of 66 consecutive patients (31 female, 35 male; mean age: 53 years, range: 25 – 76 years) who underwent posterior lumbar instrumentation with the Dynesys Transition Optima (DTO) implant (Zimmer-Biomet Spine, Warsaw, IN) hybrid dynamic stabilization and fusion system over a 10-year period. The median length of follow-up was five years. DTO consists of pedicle screw fixation coupled to a rigid rod as well as a flexible longitudinal connecting system. All patients had symptoms of back pain and neurogenic claudication refractory to non-surgical treatment. Patients underwent lumbar arthrodesis surgery in which the hybrid system was used for stabilization instead of arthrodesis of the stenotic adjacent level.

Results: Indications for DTO instrumentation were primary degenerative disc disease (n = 52) and failed back surgery syndrome (n = 14). The most common dynamically stabilized and fused segments were L3-L4 (n = 37) and L5-S1 (n = 33), respectively. Thirty-eight patients (56%) underwent decompression at the dynamically stabilized level, and 57 patients (86%) had an interbody device placed at the level of arthrodesis. Complications during the follow-up period included a single case of screw breakage and a single case of pseudoarthrosis. Ten patients (15%) subsequently underwent conversion of the dynamic stabilization portion of their DTO instrumentation to rigid spinal arthrodesis.

Conclusion: The DTO system represents a novel hybrid dynamic stabilization and fusion construct. This 10-year experience found the device to be highly effective as well as safe. The technique may serve as an alternative to multilevel arthrodesis. Implantation of a motion-preserving dynamic stabilization device immediately adjacent to a fused level instead of extending a rigid construct may reduce the subsequent development of adjacent-segment disease in this patient population.



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Ahmed Kashkoush

Department of Neurological Surgery, University of Pittsburgh Medical Center

Nitin Agarwal

Department of Neurological Surgery, University of Pittsburgh Medical Center

Erin Paschel, None

Department of Neurological Surgery, University of Pittsburgh Medical Center

Ezequiel Goldschmidt

Department of Neurological Surgery, University of Pittsburgh Medical Center

Peter C. Gerszten, None

Department of Neurological Surgery, University of Pittsburgh Medical Center

For correspondence:
gerspc@upmc.edu

Ahmed Kashkoush

Department of Neurological Surgery, University of Pittsburgh Medical Center

Nitin Agarwal

Department of Neurological Surgery, University of Pittsburgh Medical Center

Erin Paschel, None

Department of Neurological Surgery, University of Pittsburgh Medical Center

Ezequiel Goldschmidt

Department of Neurological Surgery, University of Pittsburgh Medical Center

Peter C. Gerszten, None

Department of Neurological Surgery, University of Pittsburgh Medical Center

For correspondence:
gerspc@upmc.edu