Radiological factors affecting functional outcome after the implantation of BDYN™ dynamic stabilization system for low-grade lumbar degenerative spondylolisthesis - 20/07/23
, Joe Faddoul a, b , Bilal Tarabay a , Christian Attieh a , Sarkis Taifour c , Bouchra Benkessou d , Ibrahim Obeid e , Georges Naïm Abi Lahoud a, f Highlights |
• | A retrospective non-randomized single center study was conducted over 5years, including 50 adults treated with BDYN™ dynamic stabilization system for low-grade lumbar degenerative spondylolisthesis; pre- and postoperative clinical and radiological evaluation were performed, with a mean follow-up of 24months, to determine radiological factors affecting functional outcomes and prognosis. |
• | The BDYN™ system appears safe, well-tolerated, and could be an effective alternative to fusion techniques in the treatment of patients with low-grade lumbar degenerative spondylolisthesis while preserving motion and theoretically preserving the adjacent vertebral segment. |
• | Clinically: 80% (40 patients) had a satisfying functional result in terms of daily life activity, pain and walking distance, and 20% (10 patients) were considered as having a poor outcome according to the ODI score. |
• | Radiological findings: the loss of segmental lordosis, mainly due to the disc kyphosis at the level of the lumbar degenerative spondylolisthesis was statistically associated with bad functional outcomes (18° for ODI decrease>15 versus 11° for ODI decrease<15). There is also a tendency showing that a higher Pfirmann disc signal grade (grade IV) and a severe canal stenosis according to Schizas classification (grade C & D) are predictive of a poor result. The group of patients with bad outcome presented a higher grade of Pfirmann disc signal (grade IV) and a more severe canal stenosis (Schizas grade C and D). |
• | A kyphotic disc at the level of the lumbar degenerative spondylolisthesis should be considered a contraindication for the implantation of such BDYN™ DS device. It seems that it is better to implant the BDYN™ in lumbar degenerative spondylolisthesis with mild or moderate disc degeneration and canal stenosis. |
• | There are no radiological consequences of the device implantation on the static and the dynamic of the adjacent segments at two years postoperatively. |
Abstract |
Background |
The objectives of this study are to identify radiological factors associated with good functional outcomes after the implantation of BDYN™ dynamic stabilization system in the setting of painful low-grade degenerative lumbar spondylolisthesis (DLS).
Material and methods |
In this monocentric, retrospective study, we followed 50 patients, a 5-years period, with chronic lower back pain, radiculopathy and/or neurogenic claudication evolving for at least one year that failed conservative treatment. All patients presented low-grade DLS and underwent lumbar dynamic stabilization. Radiological and clinical outcomes were assessed preoperatively and 24months after surgery. Functional evaluation was based on the Oswestry Disability Index (ODI), the Numerical Rating Scale (NRS), and the Walking Distance (WD). Radiological analysis was based on lumbar X-rays and MRI parameters. Patients were divided into two groups according to the reduction in the postoperative ODI score (more or less than 15 points), and statistical analysis was performed between both groups to find predictive radiological factors for a satisfying functional outcome.
Results |
Clinically, 80% (40 patients) had a satisfying functional result, and 20% (10 patients) were considered having a poor outcome according to the ODI score. Radiologically, the loss in segmental lordosis was statistically associated with bad functional outcomes (18° for ODI decrease>15 versus 11° for ODI decrease<15). There is also a tendency showing that a higher Pfirmann disc signal grade (grade IV) and a severe canal stenosis according to Schizas classification (grade C & D) are predictive of a poor clinical result, but that must be confirmed in future studies.
Conclusions |
BDYN™ appears safe and well-tolerated. This new device should be effective for the treatment of patients with low-grade DLS. It provides significant improvement in terms of daily life activity and pain. Moreover, we have been able to deduce that a kyphotic disc is associated with a bad functional outcome after BDYN™ device implantation. It may represent a contraindication for the implantation of such DS device. Moreover, it seems that it is better to implant BDYN™ in DLS with mild or moderate disc degeneration and canal stenosis.
Le texte complet de cet article est disponible en PDF.Keywords : BDYN™, Dynamic stabilization, Motion preservation, Low-grade lumbar degenerative spondylolisthesis, Adjacent segment degeneration, Lumbar spine, Kyphotic disc, Prognostic factors, Radiographical factors
Plan
Vol 69 - N° 4
Article 101456- juillet 2023 Retour au numéro
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