Mid-term effectiveness of Coflex interspinous dynamic internal fixation combined with spinal fusion for lumbar disc degeneration_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YAO Yicun , YE Dongping ,  LIANG Weiguo , MIAO Haixiong , WU Jinfeng , ZHOU Ziqiang

Department of Orthopedics, Guangzhou Red Cross Hospital, Guangzhou Red Cross Hospital Affiliated to Jinan University, Guangzhou Guangdong, 510220, P.R.China;

Corresponding author：

LIANG Weiguo, Email: shihonghuiyiyuan@163.com

Keywords：

Lumbar disc degeneration; dynamic fixation; Coflex; decompression fusion

DOI：

10.7507/1002-1892.201807099

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Objective To evaluate the effectiveness of Coflex interspinous dynamic internal fixation combined with spinal fusion for lumbar disc degeneration.Methods The clinical data of 39 patients with two-level lumbar disc degeneration who met the selection criteria between June 2010 and December 2011 was retrospectively analyzed. They were divided into group A (20 cases, simple lumbar decompression and fusion) and group B (19 cases, Coflex interspinous dynamic internal fixation combined with spinal fusion) according to different surgical methods. There was no significant difference in age, gender, disease diagnosis, lesion segment, disease duration, Oswestry disability index (ODI), visual analogue scale (VAS) score, and the intervertebral height, foramen intervertebral height (FIH), and range of motion (ROM) of upper operative segment and adjacent segment between the two groups (P>0.05). ODI and VAS score were used to evaluate the effectiveness before operation and at last follow-up, and the improvement rates were calculated. The intervertebral height [anterior disc height (ADH), middle disc height (MDH), and posterior disc height (PDH)], FIH, and ROM were measured and compared between the two groups.Results The operation time and intraoperative blood loss in group A were significantly more than those in group B (P<0.05), and there was no significant difference in hospitalization time between the two groups (t=0.992, P=0.328). All patients were followed up; the follow-up time was 33-50 months (mean, 40.5 months) in group A and 39-51 months (mean, 42.6 months) in group B. No complication such as displacement, loosening, or rupture of internal fixator was found in both groups. At last follow-up, ODI and VAS score of the two groups significantly improved when compared with preoperative scores (P<0.05). At last follow-up, there was no significant difference in ODI, VAS score, and improvement rate of ODI between the two groups (P>0.05); the improvement rate of VAS score in group B was significantly higher than that in group A (t=2.245, P=0.031). There was no significant difference in the intervertebral height and FIH of the upper operative segment at last follow-up between the two groups and between preoperation and last follow-up in the two groups (P>0.05). At last follow-up, the ADH of adjacent segment in group B was significantly higher than that in group A, and MDH, PDH, and FIH were significantly lower than those in group A (P<0.05). Compared with preoperation, the ADH of adjacent segment in group A decreased and MDH, PDH, and FIH increased at last follow-up (P<0.05), while all indexes in group B did not change significantly (P>0.05). The ROM of adjacent segment in group A increased significantly at last follow-up (t=2.318, P=0.026). There was significant difference in ROM of adjacent segment between the two groups (P<0.05).Conclusion The mid-term effectiveness of Coflex interspinous dynamic internal fixation combined with spinal fusion is similar to that of simple decompression fusion. For those patients whose adjacent segments of the responsible segments have degeneration but have no symptoms or mild symptoms, this treatment can slow down the adjacent segment degeneration.

Citation： YAO Yicun, YE Dongping, LIANG Weiguo, MIAO Haixiong, WU Jinfeng, ZHOU Ziqiang. Mid-term effectiveness of Coflex interspinous dynamic internal fixation combined with spinal fusion for lumbar disc degeneration. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(3): 280-286. doi: 10.7507/1002-1892.201807099 Copy

1.	Sanderson KB, Roditi D, George SZ, et al. Investigating patient expectations and treatment outcome in a chronic low back pain population. J Pain Res, 2012, 5: 15-22.
2.	Bridwell KH, Sedgewick TA, O’Brien MF, et al. The role of fusion and instrumentation in the treatment of degenerative spondylolisthesis with spinal stenosis. J Spinal Disord, 1993, 6(6): 461-472.
3.	双峰, 侯树勋. 腰椎融合术后邻近节段退变的临床研究现状. 中国修复重建外科杂志, 2013, 27(1): 110-115.
4.	Mo Z, Li D, Zhang R, et al. Comparative effectiveness and safety of posterior lumbar interbody fusion, Coflex, Wallis, and X-stop for lumbar degenerative diseases: A systematic review and network meta-analysis. Clin Neurol Neurosurg, 2018, 172: 74-81.
5.	Nachanakian A, El Helou A, Alaywan M. The interspinous spacer: a new posterior dynamic stabilization concept for prevention of adjacent segment disease. Adv Orthop, 2013, 2013: 637362.
6.	Bredow J, Löhrer L, Oppermann J, et al. Pathoanatomic risk factors for instability and adjacent segment disease in lumbar spine: how to use topping off? Biomed Res Int, 2017, 2017: 2964529.
7.	Zhu Z, Liu C, Wang K, et al. Topping-off technique prevents aggravation of degeneration of adjacent segment fusion revealed by retrospective and finite element biomechanical analysis. J Orthop Surg Res, 2015, 10: 10.
8.	Reichl M, Kueny RA, Danyali R, et al. Biomechanical effects of a dynamic topping off instrumentation in a long rigid pedicle screw construct. Clin Spine Surg, 2017, 30(4): E440-E447.
9.	姚依村, 梁伟国, 吴劲风, 等. 腰椎棘突间非融合动态稳定技术 Coflex 与 KMC 的近期疗效比较. 中国修复重建外科杂志, 2014, 28(4): 474-479.
10.	Koenders N, Rushton A, Verra ML, et al. Pain and disability after first-time spinal fusion for lumbar degenerative disorders: a systematic review and meta-analysis. Eur Spine J, 2018.
11.	de Kunder SL, van Kuijk SMJ, Rijkers K, et al. Transforaminal lumbar interbody fusion (TLIF) versus posterior lumbar interbody fusion (PLIF) in lumbar spondylolisthesis: a systematic review and meta-analysis. Spine J, 2017, 17(11): 1712-1721.
12.	张磊, 方向前, 赵兴, 等. 经椎间孔单侧入路双侧减压融合内固定术治疗腰椎管狭窄症的近期疗效观察. 中国修复重建外科杂志, 2017, 31(5): 519-526.
13.	Kong C, Lu S, Hai Y, et al. Biomechanical effect of interspinous dynamic stabilization adjacent to single-level fusion on range of motion of the transition segment and the adjacent segment. Clin Biomech (Bristol, Avon), 2015, 30(4): 355-359.
14.	Celik H, Derincek A, Koksal I. Surgical treatment of the spinal stenosis with an interspinous distraction device: do we really restore the foraminal height? Turk Neurosurg, 2012, 22(1): 50-54.
15.	Siewe J, Otto C, Knoell P, et al. Comparison of standard fusion with a " topping off” system in lumbar spine surgery: a protocol for a randomized controlled trial. BMC Musculoskelet Disord, 2011, 12: 239.
16.	Korovessis P, Repantis T, Zacharatos S, et al. Does Wallis implant reduce adjacent segment degeneration above lumbosacral instrumented fusion? Eur Spine J, 2009, 18(6): 830-840.
17.	Che W, Chen Q, Ma YQ, et al. Single-level rigid fixation combined with Coflex: a biomechanical study. Med Sci Monit, 2016, 22: 1022-1027.
18.	Aunoble S, Meyrat R, Al Sawad Y, et al. Hybrid construct for two levels disc disease in lumbar spine. Eur Spine J, 2010, 19(2): 290-296.
19.	Liu X, Liu Y, Lian X, et al. Magnetic resonance imaging on disc degeneration changes after implantation of an interspinous spacer and fusion of the adjacent segment. Int J Clin Exp Med, 2015, 8(4): 6097-6102.
20.	Glassman SD, Bridwell K, Dimar JR, et al. The impact of positive sagittal balance in adult spinal deformity. Spine (Phila Pa 1976), 2005, 30(18): 2024-2029.
21.	Gottipati P, Stine R, Ganju A, et al. The effect of positive sagittal spine balance and reconstruction surgery on standing balance. Gait Posture, 2018, 62: 227-234.
22.	Knox JB, Lonner BS. Sagittal Balance//Minimally Invasive Spinal Deformity Surgery. Vienna: Springer, 2014: 33-37.
23.	Joseph SA Jr, Moreno AP, Brandoff J, et al. Sagittal plane deformity in the adult patient. J Am Acad Orthop Surg, 2009, 17(6): 378-388.
24.	Yu SW, Yen CY, Wu CH, et al. Radiographic and clinical results of posterior dynamic stabilization for the treatment of multisegment degenerative disc disease with a minimum follow-up of 3 years. Arch Orthop Trauma Surg, 2012, 132(5): 583-589.

1. Sanderson KB, Roditi D, George SZ, et al. Investigating patient expectations and treatment outcome in a chronic low back pain population. J Pain Res, 2012, 5: 15-22.
2. Bridwell KH, Sedgewick TA, O’Brien MF, et al. The role of fusion and instrumentation in the treatment of degenerative spondylolisthesis with spinal stenosis. J Spinal Disord, 1993, 6(6): 461-472.
3. 双峰, 侯树勋. 腰椎融合术后邻近节段退变的临床研究现状. 中国修复重建外科杂志, 2013, 27(1): 110-115.
4. Mo Z, Li D, Zhang R, et al. Comparative effectiveness and safety of posterior lumbar interbody fusion, Coflex, Wallis, and X-stop for lumbar degenerative diseases: A systematic review and network meta-analysis. Clin Neurol Neurosurg, 2018, 172: 74-81.
5. Nachanakian A, El Helou A, Alaywan M. The interspinous spacer: a new posterior dynamic stabilization concept for prevention of adjacent segment disease. Adv Orthop, 2013, 2013: 637362.
6. Bredow J, Löhrer L, Oppermann J, et al. Pathoanatomic risk factors for instability and adjacent segment disease in lumbar spine: how to use topping off? Biomed Res Int, 2017, 2017: 2964529.
7. Zhu Z, Liu C, Wang K, et al. Topping-off technique prevents aggravation of degeneration of adjacent segment fusion revealed by retrospective and finite element biomechanical analysis. J Orthop Surg Res, 2015, 10: 10.
8. Reichl M, Kueny RA, Danyali R, et al. Biomechanical effects of a dynamic topping off instrumentation in a long rigid pedicle screw construct. Clin Spine Surg, 2017, 30(4): E440-E447.
9. 姚依村, 梁伟国, 吴劲风, 等. 腰椎棘突间非融合动态稳定技术 Coflex 与 KMC 的近期疗效比较. 中国修复重建外科杂志, 2014, 28(4): 474-479.
10. Koenders N, Rushton A, Verra ML, et al. Pain and disability after first-time spinal fusion for lumbar degenerative disorders: a systematic review and meta-analysis. Eur Spine J, 2018.
11. de Kunder SL, van Kuijk SMJ, Rijkers K, et al. Transforaminal lumbar interbody fusion (TLIF) versus posterior lumbar interbody fusion (PLIF) in lumbar spondylolisthesis: a systematic review and meta-analysis. Spine J, 2017, 17(11): 1712-1721.
12. 张磊, 方向前, 赵兴, 等. 经椎间孔单侧入路双侧减压融合内固定术治疗腰椎管狭窄症的近期疗效观察. 中国修复重建外科杂志, 2017, 31(5): 519-526.
13. Kong C, Lu S, Hai Y, et al. Biomechanical effect of interspinous dynamic stabilization adjacent to single-level fusion on range of motion of the transition segment and the adjacent segment. Clin Biomech (Bristol, Avon), 2015, 30(4): 355-359.
14. Celik H, Derincek A, Koksal I. Surgical treatment of the spinal stenosis with an interspinous distraction device: do we really restore the foraminal height? Turk Neurosurg, 2012, 22(1): 50-54.
15. Siewe J, Otto C, Knoell P, et al. Comparison of standard fusion with a " topping off” system in lumbar spine surgery: a protocol for a randomized controlled trial. BMC Musculoskelet Disord, 2011, 12: 239.
16. Korovessis P, Repantis T, Zacharatos S, et al. Does Wallis implant reduce adjacent segment degeneration above lumbosacral instrumented fusion? Eur Spine J, 2009, 18(6): 830-840.
17. Che W, Chen Q, Ma YQ, et al. Single-level rigid fixation combined with Coflex: a biomechanical study. Med Sci Monit, 2016, 22: 1022-1027.
18. Aunoble S, Meyrat R, Al Sawad Y, et al. Hybrid construct for two levels disc disease in lumbar spine. Eur Spine J, 2010, 19(2): 290-296.
19. Liu X, Liu Y, Lian X, et al. Magnetic resonance imaging on disc degeneration changes after implantation of an interspinous spacer and fusion of the adjacent segment. Int J Clin Exp Med, 2015, 8(4): 6097-6102.
20. Glassman SD, Bridwell K, Dimar JR, et al. The impact of positive sagittal balance in adult spinal deformity. Spine (Phila Pa 1976), 2005, 30(18): 2024-2029.
21. Gottipati P, Stine R, Ganju A, et al. The effect of positive sagittal spine balance and reconstruction surgery on standing balance. Gait Posture, 2018, 62: 227-234.
22. Knox JB, Lonner BS. Sagittal Balance//Minimally Invasive Spinal Deformity Surgery. Vienna: Springer, 2014: 33-37.
23. Joseph SA Jr, Moreno AP, Brandoff J, et al. Sagittal plane deformity in the adult patient. J Am Acad Orthop Surg, 2009, 17(6): 378-388.
24. Yu SW, Yen CY, Wu CH, et al. Radiographic and clinical results of posterior dynamic stabilization for the treatment of multisegment degenerative disc disease with a minimum follow-up of 3 years. Arch Orthop Trauma Surg, 2012, 132(5): 583-589.

Chinese Journal of Reparative and Reconstructive Surgery

Mid-term effectiveness of Coflex interspinous dynamic internal fixation combined with spinal fusion for lumbar disc degeneration

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