Re-Evaluating the Long-Term Efficacy of Semi-Rigid Fixation Using a Nitinol Spring Rod in Lumbar Surgery: A Retrospective Study on an Effective Alternative for Reducing Adjacent Segment Disease
Abstract
1. Introduction
2. Materials and Methods
2.1. Patient Population
2.2. Surgical Procedure
2.3. Radiologic Outcome Measures
2.4. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
- (1)
- Our findings indicate a lower incidence of ASD (16.9%) over a median follow-up of 13.0 years.
- (2)
- The adjacent disc height and motion were maintained compared to traditional rigid fixation.
- (3)
- There was a 5.6% incidence of mechanical complications due to rod fractures, but no patients required revision surgery due to symptoms.
- (4)
- As there were no cases of pseudarthrosis at the final follow-up in this case series, this surgical method can achieve a reasonable fusion rate.
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Harris, I.A.; Traeger, A.; Stanford, R.; Maher, C.G.; Buchbinder, R. Lumbar Spine Fusion: What Is the Evidence? Intern. Med. J. 2018, 12, 1430–1434. [Google Scholar] [CrossRef] [PubMed]
- Cheh, G.; Bridwell, K.H.; Lenke, L.G.; Buchowski, J.M.; Daubs, M.D.; Kim, Y.; Baldus, C. Adjacent Segment Disease Followinglumbar/Thoracolumbar Fusion with Pedicle Screw Instrumentation: A Minimum 5-Year Follow-Up. Spine 2007, 32, 2253–2257. [Google Scholar] [CrossRef] [PubMed]
- Ekman, P.; Möller, H.; Shalabi, A.; Yu, Y.X.; Hedlund, R. A Prospective Randomised Study on the Long-Term Effect of Lumbar Fusion on Adjacent Disc Degeneration. Eur. Spine J. 2009, 18, 1175–1186. [Google Scholar] [CrossRef] [PubMed]
- Ghiselli, G.; Wang, J.C.; Bhatia, N.N.; Hsu, W.K.; Dawson, E.G. Adjacent Segment Degeneration in the Lumbar Spine. JBJS 2004, 86, 1497–1503. [Google Scholar] [CrossRef] [PubMed]
- Harrop, J.S.; Youssef, J.A.; Maltenfort, M.; Vorwald, P.; Jabbour, P.; Bono, C.M.; Goldfarb, N.; Vaccaro, A.R.; Hilibrand, A.S. Lumbar Adjacent Segment Degeneration and Disease after Arthrodesis and Total Disc Arthroplasty. Spine 2008, 33, 1701–1707. [Google Scholar] [CrossRef]
- Helgeson, M.D.; Bevevino, A.J.; Hilibrand, A.S. Update on the Evidence for Adjacent Segment Degeneration and Disease. Spine J. 2013, 13, 342–351. [Google Scholar] [CrossRef] [PubMed]
- Kumar, M.; Baklanov, A.; Chopin, D. Correlation between Sagittal Plane Changes and Adjacent Segment Degeneration Following Lumbar Spine Fusion. Eur. Spine J. 2001, 10, 314–319. [Google Scholar] [CrossRef] [PubMed]
- Ramírez-Villaescusa, J.; Hidalgo, J.L.-T.; Ruiz-Picazo, D.; Martín-Benlloch, A. A Descriptive Study on the Adjacent Segment Degeneration Related Signs Following a Lumbar Fusion Procedure. J. Spine Surg. 2021, 7, 354. [Google Scholar] [CrossRef] [PubMed]
- Sears, W.R.; Sergides, I.G.; Kazemi, N.; Smith, M.; White, G.J.; Osburg, B. Incidence and Prevalence of Surgery at Segments Adjacent to a Previous Posterior Lumbar Arthrodesis. Spine J. 2011, 11, 11–20. [Google Scholar] [CrossRef]
- Yoon, S.G.; Lee, H.C.; Lee, S.-M. Pelvic Incidence–Lumbar Lordosis Mismatch Is Predisposed to Adjacent Segment Degeneration after Single-Level Anterior Lumbar Interbody Fusion: A Retrospective Case-Control Study. Neurospine 2023, 20, 301. [Google Scholar] [CrossRef]
- Birjandi, A. Adjacent Segment Degeneration. J. Inj. Violence Res. 2012, 4 (Suppl. S1), 8. [Google Scholar]
- Virk, S.S.; Niedermeier, S.; Yu, E.; Khan, S.N. Adjacent Segment Disease. Orthopedics 2014, 37, 547–555. [Google Scholar] [CrossRef] [PubMed]
- Zhang, L.; Li, H.-M.; Zhang, R.; Zhang, H.; Shen, C.-L. Biomechanical Changes of Adjacent and Fixed Segments through Cortical Bone Trajectory Screw Fixation Versus Traditional Trajectory Screw Fixation in the Lumbar Spine: A Finite Element Analysis. World Neurosurg. 2021, 151, e447–e456. [Google Scholar] [CrossRef] [PubMed]
- Cao, L.; Liu, Y.; Mei, W.; Xu, J.; Zhan, S. Biomechanical Changes of Degenerated Adjacent Segment and Intact Lumbar Spine after Lumbosacral Topping-Off Surgery: A Three-Dimensional Finite Element Analysis. BMC Musculoskelet. Disord. 2020, 21, 104. [Google Scholar] [CrossRef] [PubMed]
- Kuo, C.-H.; Huang, W.-C.; Wu, J.-C.; Tu, T.-H.; Fay, L.-Y.; Wu, C.-L.; Cheng, H. Radiological Adjacent-Segment Degeneration in L4–5 Spondylolisthesis: Comparison between Dynamic Stabilization and Minimally Invasive Transforaminal Lumbar Interbody Fusion. J. Neurosurg. Spine 2018, 29, 250–258. [Google Scholar] [CrossRef] [PubMed]
- Barrey, C.Y.; Ponnappan, R.K.; Song, J.; Vaccaro, A.R. Biomechanical Evaluation of Pedicle Screw-Based Dynamic Stabilization Devices for the Lumbar Spine: A Systematic Review. SAS J. 2008, 2, 159–170. [Google Scholar] [CrossRef] [PubMed]
- Li, C.; Liu, L.; Shi, J.-Y.; Yan, K.-Z.; Shen, W.-Z.; Yang, Z.-R. Clinical and Biomechanical Researches of Polyetheretherketone (Peek) Rods for Semi-Rigid Lumbar Fusion: A Systematic Review. Neurosurg. Rev. 2018, 41, 375–389. [Google Scholar] [CrossRef] [PubMed]
- Zhang, H.Y.; Park, J.Y.; Cho, B.Y. The Bioflex System as a Dynamic Stabilization Device: Does It Preserve Lumbar Motion? J. Korean Neurosurg. Soc. 2009, 46, 431. [Google Scholar] [CrossRef]
- Ritzel, H.; Amling, M.; Pösl, M.; Hahn, M.; Delling, G. The Thickness of Human Vertebral Cortical Bone and Its Changes in Aging and Osteoporosis: A Histomorphometric Analysis of the Complete Spinal Column from Thirty-Seven Autopsy Specimens. J. Bone Miner. Res. 1997, 12, 89–95. [Google Scholar] [CrossRef]
- Lin, B.; Yu, H.; Chen, Z.; Huang, Z.; Zhang, W. Comparison of the Peek Cage and an Autologous Cage Made from the Lumbar Spinous Process and Laminae in Posterior Lumbar Interbody Fusion. BMC Musculoskelet. Disord. 2016, 17, 374. [Google Scholar] [CrossRef]
- Weiner, D.K.; Distell, B.; Studenski, S.; Martinez, S.; Lomasney, L.; Bongiorni, D. Does Radiographic Osteoarthritis Correlate with Flexibility of the Lumbar Spine? J. Am. Geriatr. Soc. 1994, 42, 257–263. [Google Scholar] [CrossRef] [PubMed]
- Röllinghoff, M.; Schlüter-Brust, K.; Groos, D.; Sobottke, R.; Michael, J.W.-P.; Eysel, P.; Delank, K.S. Mid-Range Outcomes in 64 Consecutive Cases of Multilevel Fusion for Degenerative Diseases of the Lumbar Spine. Orthop. Rev. 2010, 2, e3. [Google Scholar] [CrossRef] [PubMed]
- Luo, C.-A.; Lim, A.S.; Lu, M.-L.; Chiu, P.-Y.; Lai, P.-L.; Niu, C.-C. The Surgical Outcome of Multilevel Anterior Cervical Discectomy and Fusion in Myelopathic Elderly and Younger Patients. Sci. Rep. 2022, 12, 4495. [Google Scholar] [CrossRef] [PubMed]
- Schulte, T.L.; Leistra, F.; Bullmann, V.; Osada, N.; Vieth, V.; Marquardt, B.; Lerner, T.; Liljenqvist, U.; Hackenberg, L. Disc Height Reduction in Adjacent Segments and Clinical Outcome 10 Years after Lumbar 360 Fusion. Eur. Spine J. 2007, 16, 2152–2158. [Google Scholar] [CrossRef] [PubMed]
- Kim, Y.-S.; Zhang, H.-Y.; Moon, B.-J.; Park, K.-W.; Ji, K.-Y.; Lee, W.-C.; Oh, K.-S.; Ryu, G.-U.; Kim, D.H. Nitinol Spring Rod Dynamic Stabilization System and Nitinol Memory Loops in Surgical Treatment for Lumbar Disc Disorders: Short-Term Follow Up. Neurosurg. Focus. 2007, 22, 1–9. [Google Scholar] [CrossRef]
- Massey, P.A.; Hoge, S.; Nelson, B.G.; Ogden, A.L.; Mody, M.G.; Myers, M.; Bilderback, K.; Solitro, G.; Barton, R.S. Nitinol Memory Rods Versus Titanium Rods: A Biomechanical Comparison of Posterior Spinal Instrumentation in a Synthetic Corpectomy Model. Glob. Spine J. 2021, 11, 277–282. [Google Scholar] [CrossRef] [PubMed]
- Akgün, M.; Ateş, Ö.; Günerbüyük, C.; Karadağ, M.; Özer, A. Long-Term Failure of Dynamic Rods Used in Full Dynamic Stabilization. J. Turk. Spinal Surg. 2023, 34, 137–142. [Google Scholar] [CrossRef]
- Lee, B.-J.; Bae, S.S.; Choi, H.Y.; Park, J.H.; Hyun, S.-J.; Jo, D.J.; Cho, Y.; Korean Spinal Deformity Society. Proximal Junctional Kyphosis or Failure after Adult Spinal Deformity Surgery-Review of Risk Factors and Its Prevention. Neurospine 2023, 20, 863. [Google Scholar] [CrossRef] [PubMed]
- Cazzulino, A.; Gandhi, R.; Woodard, T.; Ackshota, N.; Janjua, M.B.; Arlet, V.; Saifi, C. Soft Landing Technique as a Possible Prevention Strategy for Proximal Junctional Failure Following Adult Spinal Deformity Surgery. J. Spine Surg. 2021, 7, 26. [Google Scholar] [CrossRef] [PubMed]
- Rodnoi, P.; Le, H.; Hiatt, L.; Wick, J.; Barber, J.; Javidan, Y.; Roberto, R.; Klineberg, E.O. Ligament Augmentation with Mersilene Tape Reduces the Rates of Proximal Junctional Kyphosis and Failure in Adult Spinal Deformity. Neurospine 2021, 18, 580. [Google Scholar] [CrossRef]
- Sengupta, D.K.; Bucklen, B.; McAfee, P.C.; Nichols, J.; Angara, R.; Khalil, S. The Comprehensive Biomechanics and Load-Sharing of Semirigid Peek and Semirigid Posterior Dynamic Stabilization Systems. Adv. Orthop. 2013, 2013, 745610. [Google Scholar] [CrossRef] [PubMed]
Value | Percentage (%) | |
---|---|---|
Age (years) | 53.5 | |
Gender | ||
Female | 60 | 67.4% |
Male | 29 | 32.6% |
Follow-up period (years) | 13.0 | |
Body mass index (kg/m2) | 25.0 ± 2.9 | |
Disease | ||
Degenerative stenosis | 24 | 27% |
Degenerative spondylolisthesis | 21 | 23.6% |
Spondylolytic spondylolisthesis | 44 | 49.4% |
Uppermost instrumented vertebra | ||
L2 | 1 | 1.1% |
L3 | 22 | 24.7% |
L4 | 44 | 49.4% |
L5 | 22 | 25% |
Lowermost instrumented vertebra | ||
L4 | 6 | 6.7% |
L5 | 46 | 51.7% |
S1 | 37 | 41.6% |
Surgery level | ||
1.4 ± 0.6 | ||
1 level | 58 | 65.2% |
2 level | 26 | 29.5% |
3 level | 5 | 5.7% |
Total (N = 89) | 1-Level Surgery (N = 58) | 2-Level Surgery (N = 26) | 3-Level Surgery (N = 5) | p-Value | |
---|---|---|---|---|---|
Upper disc height preservation (%) | 84.6 ± 15.2 | 87.3 ± 9.1 | 82.8 ± 20.0 | 63.4 ± 25.7 | 0.12 |
Lower disc height preservation (%) | 89.2 ± 8.4 | 89.4 ± 8.6 | 89.1 ± 8.6 | 92.0 | 0.95 |
Spondylolisthesis | 1 | ||||
No | 84 (94.4%) | 54 (93.1%) | 25 (96.2%) | 5 (100%) | |
Yes | 5 (5.6%) | 4 (6.9%) | 1 (3.8%) | 0 (0.0%) | |
Adjacent segment disease | 0.03 * | ||||
No | 74 (83.1%) | 50 (86.2%) | 22 (84.6%) | 2 (40.0%) | |
Yes | 15 (16.9%) | 8 (13.8%) | 4 (15.4%) | 3 (60.0%) |
Measurement | Value (Mean ± SD) |
---|---|
Lumbar lordosis | |
Preoperatively | 37.8 ± 10.9° |
Immediately post-operatively | 37.9 ± 9.6° |
Final follow-up | 36.5 ± 11.4° |
Non-ASD | ASD | p-Value | |
---|---|---|---|
(n = 74) | (n = 15) | ||
Age (years) | 53.5 | 51.0 | 0.99 |
Gender | 0.13 | ||
Female | 47 (78.3%) | 13 (21.7%) | |
Male | 27 (93.1%) | 2 (6.9%) | |
BMI (kg/m2) | 24.9 ± 2.9 | 25.4 ± 2.8 | 0.54 |
Surgery level | 0.03 * | ||
1 | 50 (86.2%) | 8 (13.8%) | |
2 | 22 (84.6%) | 4 (26.7%) | |
3 | 2 (40%) | 3 (60%) | |
Follow-up periods (years) | 13.1 | 12.7 | 0.08 |
Lumbar lordosis | |||
Preoperative | 37.3 ± 11.9° | 39.5 ± 5.6° | 0.41 |
Post-operative | 35.2 ± 10.8° | 33.3 ± 9.2° | 0.33 |
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Jang, H.-J.; Moon, B.-J.; Chin, D.-K. Re-Evaluating the Long-Term Efficacy of Semi-Rigid Fixation Using a Nitinol Spring Rod in Lumbar Surgery: A Retrospective Study on an Effective Alternative for Reducing Adjacent Segment Disease. Appl. Sci. 2024, 14, 4574. https://doi.org/10.3390/app14114574
Jang H-J, Moon B-J, Chin D-K. Re-Evaluating the Long-Term Efficacy of Semi-Rigid Fixation Using a Nitinol Spring Rod in Lumbar Surgery: A Retrospective Study on an Effective Alternative for Reducing Adjacent Segment Disease. Applied Sciences. 2024; 14(11):4574. https://doi.org/10.3390/app14114574
Chicago/Turabian StyleJang, Hyun-Jun, Bong-Ju Moon, and Dong-Kyu Chin. 2024. "Re-Evaluating the Long-Term Efficacy of Semi-Rigid Fixation Using a Nitinol Spring Rod in Lumbar Surgery: A Retrospective Study on an Effective Alternative for Reducing Adjacent Segment Disease" Applied Sciences 14, no. 11: 4574. https://doi.org/10.3390/app14114574
APA StyleJang, H.-J., Moon, B.-J., & Chin, D.-K. (2024). Re-Evaluating the Long-Term Efficacy of Semi-Rigid Fixation Using a Nitinol Spring Rod in Lumbar Surgery: A Retrospective Study on an Effective Alternative for Reducing Adjacent Segment Disease. Applied Sciences, 14(11), 4574. https://doi.org/10.3390/app14114574