Anna C Rienmüller1, Sandro M Krieg2, Franziska A Schmidt3, Elias L Meyer4, Bernhard Meyer5. 1. Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str 22, 81675 Munich, Germany; Department of Orthopedic Surgery, Vienna General Hospital, Medical University Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria. 2. Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str 22, 81675 Munich, Germany. Electronic address: Sandro.Krieg@tum.de. 3. Department of Neurosurgery, Städtisches Klinikum Bogenhausen, Englschalkinger Str. 77, 81925 Munich, Germany. 4. Section for Medical Statistics, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University Vienna, Spitalgasse 23, 1090 Vienna, Austria. 5. Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Ismaninger Str 22, 81675 Munich, Germany.
Abstract
BACKGROUND CONTEXT: The concept of dynamic stabilization (DS) of the lumbar spine for treatment of degenerative instability has been introduced almost two decades ago. Dynamic stabilization follows the principle of controlling movement in the coronal plane by providing load transfer of the spinal segment without fusion and, at the same time, reducing side effects such as adjacent segment disease (ASD). So far, only little is known about revision rates after DS due to ASD and screw loosening (SL). PURPOSE: The present study aimed to evaluate the longitudinal revision rates following dynamic pedicle screw stabilization in the lumbar spine and to determine specific risk factors predictive for ASD, SL, and overall reoperation in a large cohort with considerable follow-up. DESIGN: We carried out a post hoc analysis of a prospectively collected database in a level I spine center. PATIENTS EXAMPLE: The patient sample comprised 283 (151 female/132 male) consecutive patients suffering from painful degenerative lumbar segmental instability with or without spinal stenosis who underwent DS of the lumbar spine (Ulrich Cosmic, Ulrich Medical, Ulm, Germany) between January 2008 and December 2011. OUTCOME MEASURES: Longitudinal reoperation rate and risk factors predictive for revision surgery were evaluated. METHODS: We analyzed the longitudinal reoperation rate due to ASD and SL and overall reoperation. Risk factors such as age, gender, body mass index, lumbar lordosis (LL), number of segments, and number of previous surgeries were taken into account. Regular and mixed model logistic regressions were performed to determine risk factors for revision surgery on a patient and on a screw level. RESULTS: The mean age was 65.7±10.2 years (range 31-88). One hundred thirty-two patients were stabilized in 1 segment, 134 in 2 segments, 15 in 3 segments, and 2 patients in 4 segments. Reoperation rate for ASD and SL after 1 year was 7.4 %, after 2 years was 15.0%, and after a mean follow-up of 51.4±15 months was 22.6%. Reasons for revision were SL in 19 cases (6.6%), ASD in 39 cases (13.7%), SL and ASD in 6 cases, hematoma in 2 cases (0.7%), cerebrospinal fluid fistulae in 3 cases (1.1%), infection in 6 cases (2.1%), and implant failure in 1 case (0.4%). The patients' age, the number of stabilized segments, and the number of previous surgeries and postoperative LL had a significant influence on the probability for revision surgery. CONCLUSIONS: Reoperation rates after DS of the lumbar spine are comparable with rigid fixations. The younger the patient and the more segments are involved, the lower the LL and the more previous surgeries were found, the higher was the risk of revision. Risk of revision was almost twice as high in men compared with women. We therefore conclude that for clear clinical indication and careful evaluation of preoperative imaging data, DS using the Cosmic system seems to be a possible option. The presented data will help to further tailor indication and patient selection.
BACKGROUND CONTEXT: The concept of dynamic stabilization (DS) of the lumbar spine for treatment of degenerative instability has been introduced almost two decades ago. Dynamic stabilization follows the principle of controlling movement in the coronal plane by providing load transfer of the spinal segment without fusion and, at the same time, reducing side effects such as adjacent segment disease (ASD). So far, only little is known about revision rates after DS due to ASD and screw loosening (SL). PURPOSE: The present study aimed to evaluate the longitudinal revision rates following dynamic pedicle screw stabilization in the lumbar spine and to determine specific risk factors predictive for ASD, SL, and overall reoperation in a large cohort with considerable follow-up. DESIGN: We carried out a post hoc analysis of a prospectively collected database in a level I spine center. PATIENTS EXAMPLE: The patient sample comprised 283 (151 female/132 male) consecutive patients suffering from painful degenerative lumbar segmental instability with or without spinal stenosis who underwent DS of the lumbar spine (Ulrich Cosmic, Ulrich Medical, Ulm, Germany) between January 2008 and December 2011. OUTCOME MEASURES: Longitudinal reoperation rate and risk factors predictive for revision surgery were evaluated. METHODS: We analyzed the longitudinal reoperation rate due to ASD and SL and overall reoperation. Risk factors such as age, gender, body mass index, lumbar lordosis (LL), number of segments, and number of previous surgeries were taken into account. Regular and mixed model logistic regressions were performed to determine risk factors for revision surgery on a patient and on a screw level. RESULTS: The mean age was 65.7±10.2 years (range 31-88). One hundred thirty-two patients were stabilized in 1 segment, 134 in 2 segments, 15 in 3 segments, and 2 patients in 4 segments. Reoperation rate for ASD and SL after 1 year was 7.4 %, after 2 years was 15.0%, and after a mean follow-up of 51.4±15 months was 22.6%. Reasons for revision were SL in 19 cases (6.6%), ASD in 39 cases (13.7%), SL and ASD in 6 cases, hematoma in 2 cases (0.7%), cerebrospinal fluid fistulae in 3 cases (1.1%), infection in 6 cases (2.1%), and implant failure in 1 case (0.4%). The patients' age, the number of stabilized segments, and the number of previous surgeries and postoperative LL had a significant influence on the probability for revision surgery. CONCLUSIONS: Reoperation rates after DS of the lumbar spine are comparable with rigid fixations. The younger the patient and the more segments are involved, the lower the LL and the more previous surgeries were found, the higher was the risk of revision. Risk of revision was almost twice as high in men compared with women. We therefore conclude that for clear clinical indication and careful evaluation of preoperative imaging data, DS using the Cosmic system seems to be a possible option. The presented data will help to further tailor indication and patient selection.
Authors: Ali Fahir Özer; Göktuğ Akyoldaş; Orhun Mete Çevik; Ahmet Levent Aydın; Mehdi Hekimoğlu; Mehdi Sasani; Tunç Öktenoğlu; Önder Çerezci; Tuncer Süzer Journal: Int J Spine Surg Date: 2022-06-16
Authors: Gerhard Bratschitsch; Paul Puchwein; Ines Zollner-Schwetz; Patrick Sadoghi; Roman Radl; Andreas Leithner; Lukas Leitner Journal: Global Spine J Date: 2020-09-21