Dynamic Stabilization vs Fusion in Lumbar Degenerative Diseases

The inclusion and exclusion of studies for the meta-analysis were based on the following criteria. (1) For participants, the study population consisted of patients who satisfied the following criteria: aged 18 years or older; mean follow-up period ≥ 2 years; suffering from lumbar degenerative diseases, including disc herniation, lumbar spinal stenosis, and grade I degenerative spondylolisthesis; and having 1–4 fixed segments in the lumbar. Studies on patients with grade II or higher spondylolisthesis, ankylosis spondylitis, spinal tumor, and severe spinal deformity were excluded. (2) The intervention in the experimental group was dynamic DS. Studies on hybrid dynamic stabilization and other kinds of dynamic stabilization, including Coflex, Wallis, and X-stop systems were excluded. (3) For comparison, the intervention in the control group was instrumented fusion methods, including posterior lumbar interbody fusion, transforaminal lumbar interbody fusion (TLIF), and posterolateral fusion. (4) In terms of outcomes, studies were eligible if they satisfied at least one of the following outcomes: clinical outcomes at final follow-up (VAS and ODI scores, screw loosening and breakage, surgical revision), ASP (ASDeg and ASDis), and radiographical outcomes (postoperative ROM and disc heigh). ASDeg (radiographic ASD) represents radiographic etiologies adjacent to the surgically treated spinal level that involves loss of disc height, disc degeneration, stenosis, instability, or hypertrophic facet arthritis, regardless of the presence of symptoms. [8 (link)] ASDis (symptomatic ASD) is a clinical symptom (manifested as pain, numbness, or the other symptoms caused by nerve compression) that is correlated with radiographic changes in adjacent segments. [2 (link), 8 (link)] The primary outcomes considered were radiographic outcomes and ASP. (5) For study design, randomized controlled trials (RCTs) or comparative studies were eligible. Case series, case reports, reviews, and conference reports were excluded.

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Zhou L.P., Zhang R.J., Wang J.Q., Zhang H.Q., Shang J., Gao Y., Jia C.Y., Ding J.Y., Zhang L, & Shen C.L. (2023). Medium and long-term radiographic and clinical outcomes of Dynesys dynamic stabilization versus instrumented fusion for degenerative lumbar spine diseases. BMC Surgery, 23, 46.

Publication 2023

Ankylosis Conference Deformity Disc degeneration Disc herniation Hybrid Hypertrophic arthritis Lumbar Nerve Pain Patients Radiographic Spinal stenosis Spinal tumor Spondylitis Spondylolisthesis Stenosis Surgical revision Surgically

Corresponding Organization :

Other organizations : First Affiliated Hospital of Anhui Medical University, Anhui Medical University, University of Science and Technology of China

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Variable analysis

independent variables

Dynamic DS (dynamic stabilization)

dependent variables

Clinical outcomes at final follow-up (VAS and ODI scores, screw loosening and breakage, surgical revision)
ASP (ASDeg and ASDis)
Radiographical outcomes (postoperative ROM and disc height)

control variables

Participants aged 18 years or older
Mean follow-up period ≥ 2 years
Suffering from lumbar degenerative diseases, including disc herniation, lumbar spinal stenosis, and grade I degenerative spondylolisthesis
Having 1–4 fixed segments in the lumbar
Instrumented fusion methods, including posterior lumbar interbody fusion, transforaminal lumbar interbody fusion (TLIF), and posterolateral fusion

controls

Instrumented fusion methods, including posterior lumbar interbody fusion, transforaminal lumbar interbody fusion (TLIF), and posterolateral fusion
Studies on patients with grade II or higher spondylolisthesis, ankylosis spondylitis, spinal tumor, and severe spinal deformity, Studies on hybrid dynamic stabilization and other kinds of dynamic stabilization, including Coflex, Wallis, and X-stop systems

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