Dynamic Neutralization System versus Posterior Lumbar Interbody Fusion for Lumbar Degenerative Disease: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 DUXing ,  OUYun-sheng , ZHUYong , ZHAOZeng-hui , JIANGDian-ming

Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing Yuzhong 400016, China;

Corresponding author：

OUYun-sheng, Email: ouyunsheng2001@163.com

Keywords：

Dynesys; Posterior lumbar interbody fusion; Lumbar degenerative disease; Meta-analysis

DOI：

10.7507/1672-2531.20160214

Video：

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Objective To systematically review the effectiveness and safety of dynamic neutralization system (Dynesys) versus posterior lumbar interbody fusion (PLIF) for lumbar degenerative disease. Methods Databases including PubMed, EMbase, The Cochrane Library (Issue 5, 2016), CNKI, CBM, VIP and WanFang Data were searched to collect studies about Dynesys versus PLIF for lumbar degenerative disease from inception to May 31st 2016. Two reviewers independently screened literature, extracted data, and evaluated the methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.3 software. Results A total of 22 studies involving 1 482 patients were included. The results of meta-analysis showed that, compared with PLIF, Dynesys could reduce operative time (MD=-29.62, 95%CI -36.67 to -22.57), operative blood loss (MD=-112.10, 95%CI -130.60 to -93.61), length of hospital stay (MD=-2.62, 95%CI -4.96 to -0.28), postoperative adjacent segment ROM (MD=-1.29, 95%CI -1.72 to -0.86) and maintain postoperative operated segment ROM (MD=3.53, 95%CI 1.99 to 5.08). There were no significant differences between two groups in postoperative ODI (MD=-1.51, 95%CI -3.58 to 0.55), postoperative back VAS (MD=-0.15, 95%CI -0.38 to 0.08), postoperative leg VAS (MD=-0.09, 95%CI -0.22 to 0.04) and postoperative complications (OR=0.69, 95%CI 0.45 to 1.06). Conclusion The current evidence shows that compared with PLIF, Dynesys for lumbar degenerative disease has shorter operative time, less operative blood loss, shorter hospitalization days, and Dynesys can also maintain operated segment ROM and delay the degeneration of adjacent segment. Due to the limited quality of the included studies, more studies are needed to verify the above conclusion.

Citation： DUXing, OUYun-sheng, ZHUYong, ZHAOZeng-hui, JIANGDian-ming. Dynamic Neutralization System versus Posterior Lumbar Interbody Fusion for Lumbar Degenerative Disease: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2016, 16(12): 1414-1422. doi: 10.7507/1672-2531.20160214 Copy

1.	Schizas C, Kulik G, Kosmopoulos V. Disc degeneration:current surgical options. Eur cell Mater, 2010, 20:306-315.
2.	Huang RC, Girardi FP, Lira MR, et al. Advantages and disadvantages of nonfusion technology in spine surgery. Orthop Clin North Am, 2005, 36(3):263-269.
3.	Miyakoshi N, Abe E, Shimada Y, et al. Outcome of one-level posterior lumbar interbody fusion for spondylolisthesis and postoperative intervertebral disc degeneration adjacent to the fusion. Spine, 2000, 25(14):1837-1842.
4.	Okuda S, Iwasaki M, Miyauchi A, et al. Risk factors for adjacent segment degeneration after PLIF. Spine, 2004, 29(14):1535-1540.
5.	Kumar MN, Baklanov A, Chopin D. Correlation between sagittal plane changes and adjacent segment degeneration following lumbar spine fusion. Eur Spine J, 2001, 10(4):314-319.
6.	Chou WY, Hsu CJ, Chang WN, et al. Adjacent segment degeneration after lumbar spinal posterolateral fusion with instrumentation in elderly patients. Arch Orthop Trauma Surg, 2002, 122(1):39-43.
7.	Resnick DK, Choudhri TF, Dailey AT, et al. Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 5:Correlation between radiographic and functional outcome. J Neurosurg Spine, 2005, 2(6):658-661.
8.	Schwarzenbach O, Berlemann U, Stoll TM, et al. Posterior dynamic stabilization system DYNESYS. Orthop Clin North Am, 2005, 26(3):363-372.
9.	庞晓东, 杨洪, 陈希霞, 等. Dynesys动态稳定系统治疗腰椎多节段退变性疾病. 脊柱外科杂志, 2014, 12(1):11-14.
10.	刘园桐, 镇万新. Dynesys动态中和系统治疗腰椎退行性疾病的研究近况. 中国矫形外科杂志, 2015, 23(9):811-814.
11.	Liu C, Wang L, Tian JW. Early clinical effects of the Dynesys system plus transfacet decompression through the Wiltse approach for the treatment of lumbar degenerative diseases. Med Sci Monit, 2014, 20:853-859.
12.	Sapkas G, Mavrogenis AF, Starantzis KA, et al. Outcome of a dynamic neutralization system for the spine. Orthopedics, 2012, 35(10):1497-1502.
13.	Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. The Cochrane Collaboration, 2011.[2012-03-20] Available at:http://www.cochrane-handbook.org.
14.	Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in metaanalyses. Eur J Epidemiol, 2010, 25(9):603-605.
15.	王孟, 李坤, 王飞, 等. 非融合技术与腰椎融合术治疗腰椎退变性疾病的早期疗效观察. 临床骨科杂志, 2012, 15(1):10-12.
16.	Yu SW, Yang SC, Ma CH, et al. Comparison of Dynesys posterior stabilization and posterior lumbar interbody fusion for spinal stenosis L4L5. Acta Orthop Belg, 2012, 78(2):230-239.
17.	卫沛然, 邹德威, 陈晓明, 等. 后路减压Dynesys动态固定与后路减压融合内固定治疗单节段腰椎退行性疾病的临床疗效的比较. 颈腰痛杂志, 2014, 35(2):90-95.
18.	丁国强, 李少波, 李炎, 等. 动态中和固定系统与后路椎间融合术治疗退变性椎管狭窄的近期疗效对比研究. 现代生物医学进展, 2014, 14(31):6151-6155.
19.	李江龙, 刘继波, 周鹏, 等. Dynesys动态中和系统和经后路椎间融合术治疗腰椎退行性变的疗效比较. 中国现代医学杂志, 2014, 24(25):104-107.
20.	吕乔, 刘卫华, 程微, 等. Dynesys 动态内固定与融合术治疗腰椎退变疾病的对比研究.河北医药, 2015, 21(4):603-605.
21.	黄鹏. 非融合动态内固定系统治疗腰间盘突出伴腰椎不稳的疗效研究. 医学综述, 2016, 22(5):986-988.
22.	Haddad B, Makki D, Konan S, et al. Dynesys dynamic stabilization:less good outcome than lumbar fusion at 4-year follow-up. Acta Orthop Belg, 2012, 79(1):97-103.
23.	杨兵, 江庭彪. 动态中和系统与后路腰椎椎间融合治疗腰椎退行性变的比较研究. 中国修复重建外科杂志, 2013, 27(2):140-144.
24.	樊友亮, 吴一雄, 胡辉东, 等. 经椎弓根动态稳定系统(Dynesys)与后路椎间融合治疗腰椎管狭窄的临床比较研究. 中国骨与关节损伤杂志, 2013, 28(11):1016-1019.
25.	Yang MY, Li C, Chen ZQ, et al. Short term outcome of posterior dynamic stabilization system in degenerative lumbar diseases. Indian J Orthop, 2014, 48(6):574-581.
26.	张阳, 李放, 单建林, 等. Dynesys动态内固定与融合术治疗腰椎退变疾病的对比研究. 脊柱外科杂志, 2014, 12(1):19-24.
27.	肖进飞, 张阳, 李放, 等. Dynesys动态内固定与融合术治疗L4/5单节段退变疾病的疗效对比. 中国脊柱脊髓杂志, 2014, 20(10):873-878.
28.	杨峰, 何大为, 朱晓东, 等. Dynesys动态固定与腰椎融合固定治疗腰椎退变性疾病的临床比较研究. 第二军医大学学报, 2014, 35(10):1145-1150.
29.	陈博来, 林涌鹏, 许鸿智. Dynesys动态稳定系统与坚强固定治疗单节段腰椎管狭窄症对术后相邻节段退变影响的比较. 广东医学, 2014, 35(4):553-555.
30.	彭超, 何智勇, 母建松, 等. Dynesys动态稳定系统置入内固定与后路腰椎间融合修复腰椎退行性病的比较. 中国组织工程研究, 2014, 18(44):7117-7121.
31.	汪凡栋, 郑佳状, 陈宇, 等. Dynesys 动态固定系统在腰椎退行性病变中的应用. 河北医药, 2015, 37(13):1948-1951.
32.	叶玉国, 伍骥, 郑超, 等. L3~5节段退变性疾病融合与非融合术式的选择. 安徽医科大学学报, 2015, 50(3):364-367.
33.	包先国, 孙天胜, 侯景明, 等. Dynesys动态内固定与腰椎融合手术的对比分析. 南京医科大学学报(自然科学版), 2015, 35(2):225-227.
34.	Fei H, Xu J, Wang S, et al. Comparison between posterior dynamic stabilization and posterior lumbar interbody fusion in the treatment of degenerative disc disease:a prospective cohort study. J Orthop Surg Res, 2015, 10:87.
35.	Wang Q, Liu J, Shi Y, et al. Short-term effects of a dynamic neutralization system (Dynesys) for multi-segmental lumbar disc herniation. Eur Spine J, 2016, 25(5):1409-1416.
36.	Zhang Y, Shan JL, Liu XM, et al. Comparison of the Dynesys Dynamic Stabilization System and Posterior Lumbar Interbody Fusion for Lumbar Degenerative Disease. PLoS One, 2016, 11(1):e0148071.
37.	Fritzell P, Hagg O, Nordwall A, et al. Complications in lumbar fusion surgery for chronic low back pain:comparison of three surgical techniques used in a prospective randomized study. A report from the Swedish Lumbar Spine Study Group. Eur Spine J, 2003, 12(2):178-189.
38.	梁春红, 丁亮华, 吴采荣, 等. Dynesys动态稳定系统与腰椎退变性疾病. 国际骨科学杂志, 2009, 9(2):358-361.
39.	Stoll TM, Dubois G, Schwarzenbach O. The dynamic neutralization system for the spine:a multi-center study of a novel non-fusion system. Eur Spine J, 2002, 11(2S):S170-S178.
40.	Schnake KJ, Schaeren S, Jeanneret B. Dynamic stabilization in addition to decompression for lumbar spinal stenosis with degenerative spondylolisthesis. Spine, 2006, 31(4):442-429.
41.	Bordes-Monmeneu M, Bordes-Garcia V, Rodrigo-Baeza F, et al. System of dynamic neutralization in the lumbar spine:Experience on 94 cases. Neurocirugia, 2005, 16(6):499-506.
42.	Lee SE, Park SB, Jahng TA, et al. Clinical experience of the dynamic stabilization system for the degenerative spine disease. J Korean Neurosurg Soc, 2008, 43(5):221-226.
43.	Hu Y, Gu YJ, Xu RM, et al. Short-term clinical observation of the Dynesys neutralization system for the treatment of degenerative disease of the lumbar vertebrae. Orthop Surg, 2011, 3(3):167-175.
44.	Wang M, Li K, Wang F, et al. The early clinical observation about Dynesys and lumbar interbody fusion in treatment of lumbar degenerative disease. J Clin Orthop, 2012, 15:10-12.
45.	Lee CH, Jahng TA, Hyun SJ, et al. Dynamic stabilization using the Dynesys system versus posterior lumbar interbody fusion for the treatment of degenerative lumbar spinal disease:a clinical and radiological outcomes-based meta-analysis. Neurosurg Focus, 2016, 40(1):E7.
46.	Grob D, Benini A, Junge A, et al. Clinical experience with the Dynesys semi-rigid fixation system for the lumbar spine:Surgical and patient-oriented outcome in 50 cases after an average of 2 years. Spine, 2005, 30(3):324-331.
47.	Bothmann M, Kast E, Boldt GJ, et al. Dynesys fixation for lumbar spine degeneration. Neurosurg Rev, 2008, 31(2):189-196.
48.	Zhou ZJ, Xia P, Zhao X, et al. Can posterior dynamic stabilization reduce the risk of adjacent segment deterioration? Turk Neurosurg, 2013, 23(5):579-589.
49.	Cakir B, Carazzo C, Schmidt R, et al. Adjacent segment mobility after rigid and semi-rigid instrumentation of the lumbar spine. Spine, 2009, 34(12):1287-1291.
50.	Schaeren S, Broger I, Jeanneret B. Minimum four-year followup of spinal stenosis with degenerative spondylolisthesis treated with decompression and dynamic stabilization. Spine, 2008, 33(18):E636-642.
51.	Vaga S, Brayda-Bruno M, Perona F, et al. Molecular MR imaging for the evaluation of the effect of dynamic stabilization on lumbar intervertebral discs. Eur Spine J, 2009, 18(1):40-48.
52.	张阳, 李放, 单建林, 等. Dynesys系统治疗单节段与多节段腰椎退变疾病的对比研究. 中国骨与关节疾病杂志, 2013, 2(6):308-310.
53.	Dubois G. Dynamic stabilization with the Dynesys system and the dynamic transition option DTO implant:philosophy-concept surgical technique. Interact Surg, 2008, 3(4):239-244.
54.	Sapkas G, Mavrogenis AF, Starantzis KA, et al. Outcome of a dynamic neutralization system for the spine. Orthopedics, 2012, 35(10):e1497-502.
55.	Ko CC, Tsai HW, Huang WC, et al. Screw loosening in the Dynesys stabilization system:Radiographic evidence and effect on outcomes. Neurosurg Focus, 2010, 28:E10.
56.	Pham MH, Mehta VA, Patel NN, et al. Complications associated with the Dynesys dynamic stabilization system:a comprehensive review of the literature. Neurosurg Focus, 2016, 40(1):E2.

1. Schizas C, Kulik G, Kosmopoulos V. Disc degeneration:current surgical options. Eur cell Mater, 2010, 20:306-315.
2. Huang RC, Girardi FP, Lira MR, et al. Advantages and disadvantages of nonfusion technology in spine surgery. Orthop Clin North Am, 2005, 36(3):263-269.
3. Miyakoshi N, Abe E, Shimada Y, et al. Outcome of one-level posterior lumbar interbody fusion for spondylolisthesis and postoperative intervertebral disc degeneration adjacent to the fusion. Spine, 2000, 25(14):1837-1842.
4. Okuda S, Iwasaki M, Miyauchi A, et al. Risk factors for adjacent segment degeneration after PLIF. Spine, 2004, 29(14):1535-1540.
5. Kumar MN, Baklanov A, Chopin D. Correlation between sagittal plane changes and adjacent segment degeneration following lumbar spine fusion. Eur Spine J, 2001, 10(4):314-319.
6. Chou WY, Hsu CJ, Chang WN, et al. Adjacent segment degeneration after lumbar spinal posterolateral fusion with instrumentation in elderly patients. Arch Orthop Trauma Surg, 2002, 122(1):39-43.
7. Resnick DK, Choudhri TF, Dailey AT, et al. Guidelines for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 5:Correlation between radiographic and functional outcome. J Neurosurg Spine, 2005, 2(6):658-661.
8. Schwarzenbach O, Berlemann U, Stoll TM, et al. Posterior dynamic stabilization system DYNESYS. Orthop Clin North Am, 2005, 26(3):363-372.
9. 庞晓东, 杨洪, 陈希霞, 等. Dynesys动态稳定系统治疗腰椎多节段退变性疾病. 脊柱外科杂志, 2014, 12(1):11-14.
10. 刘园桐, 镇万新. Dynesys动态中和系统治疗腰椎退行性疾病的研究近况. 中国矫形外科杂志, 2015, 23(9):811-814.
11. Liu C, Wang L, Tian JW. Early clinical effects of the Dynesys system plus transfacet decompression through the Wiltse approach for the treatment of lumbar degenerative diseases. Med Sci Monit, 2014, 20:853-859.
12. Sapkas G, Mavrogenis AF, Starantzis KA, et al. Outcome of a dynamic neutralization system for the spine. Orthopedics, 2012, 35(10):1497-1502.
13. Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. The Cochrane Collaboration, 2011.[2012-03-20] Available at:http://www.cochrane-handbook.org.
14. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in metaanalyses. Eur J Epidemiol, 2010, 25(9):603-605.
15. 王孟, 李坤, 王飞, 等. 非融合技术与腰椎融合术治疗腰椎退变性疾病的早期疗效观察. 临床骨科杂志, 2012, 15(1):10-12.
16. Yu SW, Yang SC, Ma CH, et al. Comparison of Dynesys posterior stabilization and posterior lumbar interbody fusion for spinal stenosis L4L5. Acta Orthop Belg, 2012, 78(2):230-239.
17. 卫沛然, 邹德威, 陈晓明, 等. 后路减压Dynesys动态固定与后路减压融合内固定治疗单节段腰椎退行性疾病的临床疗效的比较. 颈腰痛杂志, 2014, 35(2):90-95.
18. 丁国强, 李少波, 李炎, 等. 动态中和固定系统与后路椎间融合术治疗退变性椎管狭窄的近期疗效对比研究. 现代生物医学进展, 2014, 14(31):6151-6155.
19. 李江龙, 刘继波, 周鹏, 等. Dynesys动态中和系统和经后路椎间融合术治疗腰椎退行性变的疗效比较. 中国现代医学杂志, 2014, 24(25):104-107.
20. 吕乔, 刘卫华, 程微, 等. Dynesys 动态内固定与融合术治疗腰椎退变疾病的对比研究.河北医药, 2015, 21(4):603-605.
21. 黄鹏. 非融合动态内固定系统治疗腰间盘突出伴腰椎不稳的疗效研究. 医学综述, 2016, 22(5):986-988.
22. Haddad B, Makki D, Konan S, et al. Dynesys dynamic stabilization:less good outcome than lumbar fusion at 4-year follow-up. Acta Orthop Belg, 2012, 79(1):97-103.
23. 杨兵, 江庭彪. 动态中和系统与后路腰椎椎间融合治疗腰椎退行性变的比较研究. 中国修复重建外科杂志, 2013, 27(2):140-144.
24. 樊友亮, 吴一雄, 胡辉东, 等. 经椎弓根动态稳定系统(Dynesys)与后路椎间融合治疗腰椎管狭窄的临床比较研究. 中国骨与关节损伤杂志, 2013, 28(11):1016-1019.
25. Yang MY, Li C, Chen ZQ, et al. Short term outcome of posterior dynamic stabilization system in degenerative lumbar diseases. Indian J Orthop, 2014, 48(6):574-581.
26. 张阳, 李放, 单建林, 等. Dynesys动态内固定与融合术治疗腰椎退变疾病的对比研究. 脊柱外科杂志, 2014, 12(1):19-24.
27. 肖进飞, 张阳, 李放, 等. Dynesys动态内固定与融合术治疗L4/5单节段退变疾病的疗效对比. 中国脊柱脊髓杂志, 2014, 20(10):873-878.
28. 杨峰, 何大为, 朱晓东, 等. Dynesys动态固定与腰椎融合固定治疗腰椎退变性疾病的临床比较研究. 第二军医大学学报, 2014, 35(10):1145-1150.
29. 陈博来, 林涌鹏, 许鸿智. Dynesys动态稳定系统与坚强固定治疗单节段腰椎管狭窄症对术后相邻节段退变影响的比较. 广东医学, 2014, 35(4):553-555.
30. 彭超, 何智勇, 母建松, 等. Dynesys动态稳定系统置入内固定与后路腰椎间融合修复腰椎退行性病的比较. 中国组织工程研究, 2014, 18(44):7117-7121.
31. 汪凡栋, 郑佳状, 陈宇, 等. Dynesys 动态固定系统在腰椎退行性病变中的应用. 河北医药, 2015, 37(13):1948-1951.
32. 叶玉国, 伍骥, 郑超, 等. L3~5节段退变性疾病融合与非融合术式的选择. 安徽医科大学学报, 2015, 50(3):364-367.
33. 包先国, 孙天胜, 侯景明, 等. Dynesys动态内固定与腰椎融合手术的对比分析. 南京医科大学学报(自然科学版), 2015, 35(2):225-227.
34. Fei H, Xu J, Wang S, et al. Comparison between posterior dynamic stabilization and posterior lumbar interbody fusion in the treatment of degenerative disc disease:a prospective cohort study. J Orthop Surg Res, 2015, 10:87.
35. Wang Q, Liu J, Shi Y, et al. Short-term effects of a dynamic neutralization system (Dynesys) for multi-segmental lumbar disc herniation. Eur Spine J, 2016, 25(5):1409-1416.
36. Zhang Y, Shan JL, Liu XM, et al. Comparison of the Dynesys Dynamic Stabilization System and Posterior Lumbar Interbody Fusion for Lumbar Degenerative Disease. PLoS One, 2016, 11(1):e0148071.
37. Fritzell P, Hagg O, Nordwall A, et al. Complications in lumbar fusion surgery for chronic low back pain:comparison of three surgical techniques used in a prospective randomized study. A report from the Swedish Lumbar Spine Study Group. Eur Spine J, 2003, 12(2):178-189.
38. 梁春红, 丁亮华, 吴采荣, 等. Dynesys动态稳定系统与腰椎退变性疾病. 国际骨科学杂志, 2009, 9(2):358-361.
39. Stoll TM, Dubois G, Schwarzenbach O. The dynamic neutralization system for the spine:a multi-center study of a novel non-fusion system. Eur Spine J, 2002, 11(2S):S170-S178.
40. Schnake KJ, Schaeren S, Jeanneret B. Dynamic stabilization in addition to decompression for lumbar spinal stenosis with degenerative spondylolisthesis. Spine, 2006, 31(4):442-429.
41. Bordes-Monmeneu M, Bordes-Garcia V, Rodrigo-Baeza F, et al. System of dynamic neutralization in the lumbar spine:Experience on 94 cases. Neurocirugia, 2005, 16(6):499-506.
42. Lee SE, Park SB, Jahng TA, et al. Clinical experience of the dynamic stabilization system for the degenerative spine disease. J Korean Neurosurg Soc, 2008, 43(5):221-226.
43. Hu Y, Gu YJ, Xu RM, et al. Short-term clinical observation of the Dynesys neutralization system for the treatment of degenerative disease of the lumbar vertebrae. Orthop Surg, 2011, 3(3):167-175.
44. Wang M, Li K, Wang F, et al. The early clinical observation about Dynesys and lumbar interbody fusion in treatment of lumbar degenerative disease. J Clin Orthop, 2012, 15:10-12.
45. Lee CH, Jahng TA, Hyun SJ, et al. Dynamic stabilization using the Dynesys system versus posterior lumbar interbody fusion for the treatment of degenerative lumbar spinal disease:a clinical and radiological outcomes-based meta-analysis. Neurosurg Focus, 2016, 40(1):E7.
46. Grob D, Benini A, Junge A, et al. Clinical experience with the Dynesys semi-rigid fixation system for the lumbar spine:Surgical and patient-oriented outcome in 50 cases after an average of 2 years. Spine, 2005, 30(3):324-331.
47. Bothmann M, Kast E, Boldt GJ, et al. Dynesys fixation for lumbar spine degeneration. Neurosurg Rev, 2008, 31(2):189-196.
48. Zhou ZJ, Xia P, Zhao X, et al. Can posterior dynamic stabilization reduce the risk of adjacent segment deterioration? Turk Neurosurg, 2013, 23(5):579-589.
49. Cakir B, Carazzo C, Schmidt R, et al. Adjacent segment mobility after rigid and semi-rigid instrumentation of the lumbar spine. Spine, 2009, 34(12):1287-1291.
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Chinese Journal of Evidence-Based Medicine

Dynamic Neutralization System versus Posterior Lumbar Interbody Fusion for Lumbar Degenerative Disease: A Meta-analysis

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