Lumbar Dynamic Stabilization With 2-Stage Surgery: Early Results

Background Screw loosening, which is a major problem in dynamic systems, can be easily overcome with 2-stage surgery. In this article, the clinical and radiological results of patients undergoing dynamic stabilization with a Dynesys device in 2 stages are discussed.

Methods A total of 10 male and 13 female adult patients were included in this single-center retrospective study conducted between 2018 and 2021. The mean age of the patients was 65.6 years. All of the patients had pain complaints that affected their daily lives. Bone density T scores were determined with the dual-energy x-ray absorptiometry method before patients were admitted for surgery. In the first surgery, Dynesys system pedicle screws were inserted. After 6 months of osteointegration, Dynesys system spacers and elastic bandages were placed. Preoperative, early postoperative, and late postoperative visual analog pain scale (VAS) scores and Oswestry Disability Index (ODI) scores were determined and statistically compared.

Results Patients were followed for an average of 30 months. Complications and recurrence were not observed. Neurological deficits were not observed after patients recovered from anesthesia. Significant improvement was observed in the ODI and VAS parameters in the preoperative (ODI: 66.2%, VAS: 7.8), early postoperative (ODI: 20.3%, VAS: 2.4), and late postoperative (ODI: 6.8% and VAS: 1.1) periods. Symptomatic improvement was seen in all patients. No screw breakage or loosening was detected by radiological evaluation in any of the patients during the 2-year follow-up period.

Conclusions In our experience, the insufficiency of the proximal and distal end screws is eliminated when 2 stages of dynamic system stabilizations are completed after osteointegration of the screws.

Level of Evidence 4.