Nonfusion Does Not Prevent Adjacent Segment Disease: Dynesys Long-term Outcomes With Minimum Five-year Follow-up

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Abstract

Study Design.

Case series.

Objective.

The aim of this study was to determine the relationship between fusion and adjacent segment disease via Dynesys long-term outcomes.

Summary of Background Data.

Dynesys is a dynamic stabilization system meant to improve symptoms by stabilizing the spine without fusion and avoiding the development of adjacent segment disease. However, few studies have evaluated long-term outcomes.

Methods.

All patients were operated on with Dynesys from 2006 to 2009 by a single surgeon at a single institution. We prospectively collected 18 variables among the following categories: patient characteristics, comorbidities, surgical indications, and OR variables. We analyzed two primary endpoints: solid fusion on X-ray and clinical adjacent segment disease (ASD) both at 5 years. Secondary endpoints were time to fusion, time to ASD, reoperation, Oswestry disability index (ODI), and visual analogue scale (VAS) leg pain. We conducted a multivariate analysis via the random forest method. Mann-Whitney U test and Fisher exact test were then used to qualify relationship between variables.

Results.

We had 52 patients to review in the database. Eight had preexisting ASD. Mean follow-up was 92 months (median 87 months). Fifteen had ASD (29%) during follow-up at a mean 45 months (Median 35 months). Nine had a solid fusion (17%), 2 of which also had ASD. Mean time to fusion was 65 months (median 71 months). Differences in improvement of ODI (P = 0.005) and VAS leg pain (P = 0.002) were significant favoring patients without ASD. The multivariate analysis revealed four variables associated with ASD: prior ASD (OR 11.3, P = 0.005), neurological deficit (OR 8.5, P = 0.018), revision OR (OR 8.5, P = 0.018), and multilevel degeneration (OR 0.184, P = 0.026). No variable was associated with fusion.

Conclusion.

Dynesys was associated with a high rate of ASD over long-term follow-up despite maintaining a low fusion rate. Prior ASD was the strongest predictor of progressive ASD.

Conclusion.

Level of Evidence: 3

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