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Research ArticleFull Length Article
Open Access

An in vivo kinematic comparison of dynamic lumbar stabilization to lumbar discectomy and posterior lumbar fusion using radiostereometric analysis

Soo-An Park, Amir H. Fayyazi, Kenneth S. Yonemura, Bruce E. Fredrickson and Nathaniel R. Ordway
International Journal of Spine Surgery January 2012, 6 87-92; DOI: https://doi.org/10.1016/j.ijsp.2012.02.003
Soo-An Park
aSpine Center, Seoul St Mary's Hospital, The Catholic University of Korea, College of Medicine, Seoul, South Korea
MD, PhD
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Amir H. Fayyazi
bVSAS Orthopaedics, Institute for Advanced Healthcare, Allentown, PA
MD
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Kenneth S. Yonemura
cWasatch Neurological Surgery, Bountiful, UT
MD
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Bruce E. Fredrickson
dDepartment of Orthopedics, Syracuse VA Medical Center, Syracuse, NY
MD
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Nathaniel R. Ordway
eDepartment of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, NY
MS
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  • For correspondence: ordwayn@upstate.edu
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  • Fig. 1
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    Fig. 1

    Selected examples of biplanar radiographic images for RSA of lumbar dynamic stabilization (A), posterolateral fusion and instrumentation (B), and discectomy (C).

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    Fig. 2

    Differences of postoperative sagittal plane rotation after lumbar dynamic stabilization, posterolateral fusion and instrumentation, and discectomy. Asterisks denote statistical significance (P < .05).

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    Table 1

    Demographic data

    SexAge (y)Leveln
    Dynamic stabilization2 men and 2 women63.5 ± 11.3L2-3-41
    L4-52
    L4-5–S11
    PLF2 men and 2 women64.8 ± 8.3L2-3-41
    L3-4-52
    L4-51
    Discectomy4 men and 4 women42.8 ± 6.2L4-52
    L5-S16
    • View popup
    Table 2

    Radiostereometric segmental rotations in sagittal plane over time after dynamic stabilization with Dynesys, PLF, and discectomy

    MotionsTimeDynamic stabilization (mean ± SD) (°)PLF (mean ± SD) (°)Discectomy (mean ± SD) (°)
    Flexion1 mo1.2 ± 0.71.3 ± 0.33.3 ± 2.6
    1 y0.7 ± 0.91.3 ± 0.52.7 ± 2.8
    2 y1.0 ± 1.10.2 ± 0.21.7 ± 0.2
    Mean1.0 ± 0.9* 1.0 ± 0.6* 2.9 ± 2.4
    Extension1 mo2.3 ± 1.61.1 ± 0.92.7 ± 1.8
    1 y1.0 ± 0.41.2 ± 1.11.8 ± 1.3
    2 y1.7 ± 1.40.7 ± 0.31.8 ± 0.3
    Mean1.5 ± 1.21.1 ± 0.9* 2.3 ± 1.5
    SROM1 mo2.9 ± 0.41.5 ± 1.14.8 ± 1.9
    1 y1.8 ± 1.01.8 ± 0.35.1 ± 3.2
    2 y2.3 ± 1.70.9 ± 0.03.4 ± 0.0
    Mean2.3 ± 1.2* 1.5 ± 0.6* 4.7 ± 2.2
    • ↵* Significantly different compared with discectomy group.

    • View popup
    Table 3

    Changes of VAS for low-back pain and ODI for each group

    Postoperative
    Preoperative1 mo1 y2 y
    VAS
     Dynamic stabilization67 ±820 ± 22* 4 ± 415 ± 20
     PLF75 ± 1826 ± 15* 30 ± 2535 ± 18
     Discectomy74 ± 1431 ± 31* 39 ± 3035 ± 28
    ODI
     Dynamic stabilization56 ± 1821 ± 18* 11 ± 16* 24 ± 14
     PLF49 ± 232 ± 8* 22 ± 1828 ± 8
     Discectomy58 ± 1131 ± 18* 25 ± 1528 ± 18
    • NOTE. The range on both scales is 0 to 100, and values listed are mean ± SD.

    • ↵* Significantly changed from immediately last time point.

    • View popup
    Table 4

    Comparison with literature of SROM after dynamic stabilization

    Motion (SD) (°)
    Flexion-extensionFlexionExtensionTestsLevels measuredMeasurementLoads
    Current study2.1 (1.3)1.0 (0.9)1.5 (1.3)In vivoL2-L3, L3-L4, L4-L5, L5-S1RSAPhysiological maximal
    Cakir et al.19 4.1 (3.7)In vivoL4-L5Clinical radiographPhysiological maximal
    Kim et al.10 3.9 (5)In vivoL2-L3, L3-L4, L4-L5, L5-S1Clinical radiographPhysiological maximal
    Schulte et al.20 2.0 (0.8)1.0 (0.4)1.0 (0.4)In vitroL1-L2, L2-L3, L3-L4, L4-L5Positioning sensor5 Nm
    Cheng et al.21 1.28 (0.42)In vitroL3-L4Optoelectronic cameras6 Nm
    Freudiger et al.23 4.3 (0.9)In vitroL3-L4, L4-L5Magnetic field–based system18.3 Nm
    1.1 (0.9)12.5 Nm
    Niosi et al.12 0.5 (0.4): short spacer0.5 (0.3)In vitroL3-4Optoelectronic cameras7.5 Nm
    1.0 (0.6): standard1.1 (0.7)
    1.0 (0.5): long1.3 (0.9)
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An in vivo kinematic comparison of dynamic lumbar stabilization to lumbar discectomy and posterior lumbar fusion using radiostereometric analysis
Soo-An Park, Amir H. Fayyazi, Kenneth S. Yonemura, Bruce E. Fredrickson, Nathaniel R. Ordway
International Journal of Spine Surgery Jan 2012, 6 87-92; DOI: 10.1016/j.ijsp.2012.02.003

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An in vivo kinematic comparison of dynamic lumbar stabilization to lumbar discectomy and posterior lumbar fusion using radiostereometric analysis
Soo-An Park, Amir H. Fayyazi, Kenneth S. Yonemura, Bruce E. Fredrickson, Nathaniel R. Ordway
International Journal of Spine Surgery Jan 2012, 6 87-92; DOI: 10.1016/j.ijsp.2012.02.003
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