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Research ArticleLumbar Spine

Lumbar Dynamic Stabilization With 2-Stage Surgery: Early Results

Ali Fahir Özer, Ahmet Tulgar Başak, Muhammet Arif Özbek, Mehdi Hekimoğlu, Ahmet Levent Aydın, Özkan Ateş, Caner Günerbüyük, Turgut Akgül, Mehdi Sasani and Tunç Öktenoğlu
International Journal of Spine Surgery August 2022, 16 (4) 638-645; DOI: https://doi.org/10.14444/8306
Ali Fahir Özer
1 Neurosurgery Department, Koc University School of Medicine, Istanbul, Turkey
2 Neurosurgery Department, American Hospital, Istanbul, Turkey
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Ahmet Tulgar Başak
2 Neurosurgery Department, American Hospital, Istanbul, Turkey
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Muhammet Arif Özbek
3 Neurosurgery Department, Medipol University, Istanbul, Turkey
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Mehdi Hekimoğlu
2 Neurosurgery Department, American Hospital, Istanbul, Turkey
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Ahmet Levent Aydın
1 Neurosurgery Department, Koc University School of Medicine, Istanbul, Turkey
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Özkan Ateş
1 Neurosurgery Department, Koc University School of Medicine, Istanbul, Turkey
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Caner Günerbüyük
4 Orhopeaedics Department, Koc University School of Medicine, Istanbul, Turkey
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Turgut Akgül
4 Orhopeaedics Department, Koc University School of Medicine, Istanbul, Turkey
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Mehdi Sasani
1 Neurosurgery Department, Koc University School of Medicine, Istanbul, Turkey
2 Neurosurgery Department, American Hospital, Istanbul, Turkey
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Tunç Öktenoğlu
1 Neurosurgery Department, Koc University School of Medicine, Istanbul, Turkey
2 Neurosurgery Department, American Hospital, Istanbul, Turkey
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  • Article
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Article Figures & Data

Figures

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  • Figure 1
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    Figure 1

    Small incisions were made on the skin, and screws were inserted percutaneously through small holes.

  • Figure 2
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    Figure 2

    Appearance of guidewires in the C-arm.

  • Figure 3
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    Figure 3

    Anteroposterior image of the screws placed on the spine over the guidewires.

  • Figure 4
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    Figure 4

    Lateral image of the screws placed on the spine over the guidewires.

  • Figure 5
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    Figure 5

    Six months after surgery, osteointegration of the screws to the bone was observed on computed tomography images. In the entire vertebral body, the bone tissue was observed to be populated between the screw threads (red arrows).

  • Figure 6
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    Figure 6

    Lateral x-ray image after surgery shows the connection of the Dynesys system after osteointegration.

  • Figure 7
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    Figure 7

    Anteroposterior x-ray image after surgery.

Tables

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    Table 1

    Patients’ demographic information, diagnosis, and bone-density scores.

    Patient NoAgeGenderLevelTypeStabilization LevelsBone Density T Scores
    161ML4Degenerative disc diseaseL3-L5−3.56
    274ML2 and L4Spinal stenosisL2-L5−2.86
    358ML3Spinal instability (operated)L2-L5−2.57
    467FL3 and L4Spinal stenosisL2-iliac−3.08
    560FL4Degenerative disc diseaseL3-L5−2.88
    662ML4SpondylolisthesisL3-L5−2.76
    766FL2SpondylolysisT12-iliac−2.69
    872ML3 and L4Spinal stenosisL2-S1−3.08
    975FL4SpondylolisthesisL3-S1−3.11
    1069ML5Spinal instability (operated)L4-S1−2.73
    1156FL2SpondylolysisT12-S1−2.81
    1265FL3Degenerative disc diseaseT10-S1−2.95
    1364FL4 and L5Spinal stenosisT10-S1−2.66
    1462FL4Spinal instability (operated)L3-S1−2.82
    1560ML4Degenerative disc diseaseL2-S1−2.63
    1669FL4 and L5Spinal stenosisT10-iliac−2.58
    1763ML5 and S1SpondylolisthesisL4-İliac−2.51
    1862FL4Spinal instability (operated)L3-L5−2.59
    1976FL3 and L4Spinal stenosisL2-iliac−3.24
    2072ML4SpondylolisthesisL3-L5−3.41
    2158FL2Spinal stenosisL1-L3−2.62
    2260FL5Spinal stenosisL4-S1−2.54
    2377ML4 and L5Spinal stenosisL4-S1−3.02
    • View popup
    Table 2

    Patients’ preoperative, postoperative, and late postoperative VAS and ODI scores.

    Patient NoVAS PreoperativeVAS Early PostoperativeVAS 2-Y PostoperativeODI PreoperativeODI Early PostoperativeODI 2-Y Postoperative
    182168%17%3%
    293180%26%7%
    3103284%32%9%
    482164%14%6%
    571044%6%0%
    672154%12%5%
    772052%11%0%
    893074%28%8%
    993276%24%6%
    1082170%22%6%
    1182072%19%1%
    1283180%27%4%
    1371048%9%0%
    1472166%17%5%
    1572066%17%4%
    1683276%23%7%
    1797774%68%62%
    1872162%18%6%
    1972164%16%4%
    2072158%14%3%
    2172156%13%2%
    2283166%17%6%
    2382170%17%4%
    • Abbreviations: ODI, Oswestry Disability Index; VAS, visual analog scale.

    • View popup
    Table 3

    Data analysis of VAS scores and pairwise comparisons.

    Descriptive Statistics
    VASMeanSD N
    VAS preoperative7.830.8823
    VAS early operative2.431.1623
    VAS 2-y postoperative1.131.4223
    Pairwise Comparisons
    Measure: VAS
    (I) Time(J) TimeMean Difference (IJ)Std. Error P Valueb 95% CI for Differenceb
    Lower BoundUpper Bound
    125.39a 0.19<0.0014.885.90
    36.69a 0.27<0.0015.997.39
    21−5.39a 0.19<0.001−5.90−4.88
    31.30a 0.13<0.0010.961.64
    31−6.69a 0.27<0.001−7.39−5.99
    2−1.30a 0.13<0.001−1.64−0.96
    • Abbreviation: VAS, visual analog scale.

    • Note: Based on estimated marginal means.

    • ↵a The mean difference is significant at the.

    • ↵b Adjustment for multiple comparisons: Bonferroni.

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    Table 4

    Data analysis of ODI scores and pairwise comparisons.

    Descriptive Statistics
    ODIMeanSD N
    ODI preoperative66.2610.55423
    ODI early operative20.3012.19723
    ODI 2-y postoperative6.8712.28223
    Pairwise Comparisons
    Measure: ODI
    (I) Time(J) TimeMean Difference (IJ)Std. Error P Valueb 95% CI for Differenceb
    Lower BoundUpper Bound
    1245.957a 2.075<0.00140.57951.334
    359.391a 2.823<0.00152.07766.705
    21−45.957a 2.075<0.001−51.334−40.579
    313.435a 1.037<0.00110.74916.121
    31−59.391a 2.823<0.001−66.705−52.077
    2−13.435a 1.037<0.001−16.121−10.749
    • Abbreviation: ODI, Oswestry Disability Index.

    • Note: Based on estimated marginal means.

    • ↵a The mean difference is significant at the.

    • ↵b Adjustment for multiple comparisons: Bonferroni.

    • View popup
    Table 5

    Preoperative correlations of VAS and ODI scores.

    MeasureVAS PreoperativeODI Preoperative
    VAS preoperative
     Pearson correlation10.811a
     P value (2-tailed)<0.001
     N 2323
    ODI preoperative
     Pearson correlation0.811a 1
     P value (2-tailed)<0.001
     N 2323
    • Abbreviations: ODI, Oswestry Disability Index; VAS, visual analog scale.

    • ↵a Correlation is significant at the 0.01 level (2-tailed).

    • View popup
    Table 6

    Early postoperative correlations VAS and ODI scores.

    MeasureVAS Early PostoperativeODI Early Postoperative
    VAS early postoperative
     Pearson correlation10.960a
     P value (2-tailed)<0.001
     N 2323
    ODI early postoperative
     Pearson correlation0.960a 1
     P value (2-tailed)<0.001
     N 2323
    • Abbreviations: ODI, Oswestry Disability Index; VAS, visual analog scale.

    • ↵a Correlation is significant at the 0.01 level (2-tailed).

    • View popup
    Table 7

    Late postoperative correlations of VAS and ODI scores.

    MeasureODI 2-y PostoperativeVAS 2-y Postoperative
    ODI 2-y postoperative
     Pearson correlation10.937a
     P value (2-tailed)<0.001
     N 2323
    VAS 2-y postoperative
     Pearson correlation0.937a 1
     P value (2-tailed)<0.001
     N 2323
    • Abbreviations: ODI, Oswestry Disability Index; VAS, visual analog scale.

    • ↵a Correlation is significant at the 0.01 level (2-tailed).

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International Journal of Spine Surgery
Vol. 16, Issue 4
1 Aug 2022
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Lumbar Dynamic Stabilization With 2-Stage Surgery: Early Results
Ali Fahir Özer, Ahmet Tulgar Başak, Muhammet Arif Özbek, Mehdi Hekimoğlu, Ahmet Levent Aydın, Özkan Ateş, Caner Günerbüyük, Turgut Akgül, Mehdi Sasani, Tunç Öktenoğlu
International Journal of Spine Surgery Aug 2022, 16 (4) 638-645; DOI: 10.14444/8306

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Lumbar Dynamic Stabilization With 2-Stage Surgery: Early Results
Ali Fahir Özer, Ahmet Tulgar Başak, Muhammet Arif Özbek, Mehdi Hekimoğlu, Ahmet Levent Aydın, Özkan Ateş, Caner Günerbüyük, Turgut Akgül, Mehdi Sasani, Tunç Öktenoğlu
International Journal of Spine Surgery Aug 2022, 16 (4) 638-645; DOI: 10.14444/8306
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Keywords

  • dynamic stabilization
  • dynesys
  • osteointegration
  • 2-stage surgery

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