Romanian Neurosurgery (Jul 2024)
Outcomes of dynamic lumbar fixation in young patients with minimal lumbar instability
Abstract
Background Data: Lumbar instability is considered an essential aetiology of low back pain (LBP) which is always accompanied by considerable disability. The term ‘instability’ remains poorly defined. But it is most broadly explained by any change of the normal mechanism of spinal motion which leads to pain and/or neurological impairment. It was reported that ‘Segmental instability can be defined as a pathological reaction to the applied loads, characterized by motion in motion segments more than normal constraints. The dynamic system can stabilize an unstable segment adequately but permits more mobility in the fixed levels than the conventional fixation systems. Study design: prospective, consecutive study Patients and Methods: This study was conducted in Mansoura University hospitals over one year (starting from September 2019 till August 2020) Twenty patients who presented with back pain fulfilled our criteria and were included in this study and underwent surgery for lumbar fixation using a hybrid performance system with dynamic coupler. The history of all patients was taken and they were subjected to clinical examination and preoperative full radiological examination. Visual Analogue Scale (VAS) was used to evaluate POP. Regular follow-up visits were arranged for our cases 6 weeks, three months and 6 months postoperative. Results: This study included 20 patients (7 males and 13 females). The ages of the studied patients ranged from 20 to 33 years. 9 patients presented with L4- 5 affection, 8 patients with L3- 4 affection and three patients with L2-3 affection. The mean basal VAS score was 5.45 (range=4-6) while the mean six months VAS score was 0.40 (range=0-1) with a statistically significant difference from the basal VAS score (p ? 0.001). Also, the results show that post-operative QoL scale scores was significantly higher (p? 0.001) compared with pre-operative QoL scale scores (Physical function (54.30 vs. 67.10), limitations due to physical health (55.55 vs. 67.90)). Conclusion: The current study suggested that Dynamic lumbar fixation provides favourable and stable clinical mid-term results in patients suffering from a degenerative lumbar spinal disease (DLSD) and can be a considerable alternative to fusion surgery in these patients.
