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.	龐曉東, 楊洪, 陳希霞, 等. Dynesys動態穩定系統治療腰椎多節段退變性疾病. 脊柱外科雜志, 2014, 12(1):11-14.
10.	劉園桐, 鎮萬新. Dynesys動態中和系統治療腰椎退行性疾病的研究近況. 中國矯形外科雜志, 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, 王飛, 等. 非融合技術與腰椎融合術治療腰椎退變性疾病的早期療效觀察. 臨床骨科雜志, 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.	衛沛然, 鄒德威, 陳曉明, 等. 后路減壓Dynesys動態固定與后路減壓融合內固定治療單節段腰椎退行性疾病的臨床療效的比較. 頸腰痛雜志, 2014, 35(2):90-95.
18.	丁國強, 李少波, 李炎, 等. 動態中和固定系統與后路椎間融合術治療退變性椎管狹窄的近期療效對比研究. 現代生物醫學進展, 2014, 14(31):6151-6155.
19.	李江龍, 劉繼波, 周鵬, 等. Dynesys動態中和系統和經后路椎間融合術治療腰椎退行性變的療效比較. 中國現代醫學雜志, 2014, 24(25):104-107.
20.	呂喬, 劉衛華, 程微, 等. Dynesys 動態內固定與融合術治療腰椎退變疾病的對比研究.河北醫藥, 2015, 21(4):603-605.
21.	黃鵬. 非融合動態內固定系統治療腰間盤突出伴腰椎不穩的療效研究. 醫學綜述, 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.	楊兵, 江庭彪. 動態中和系統與后路腰椎椎間融合治療腰椎退行性變的比較研究. 中國修復重建外科雜志, 2013, 27(2):140-144.
24.	樊友亮, 吳一雄, 胡輝東, 等. 經椎弓根動態穩定系統(Dynesys)與后路椎間融合治療腰椎管狹窄的臨床比較研究. 中國骨與關節損傷雜志, 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.	張陽, 李放, 單建林, 等. Dynesys動態內固定與融合術治療腰椎退變疾病的對比研究. 脊柱外科雜志, 2014, 12(1):19-24.
27.	肖進飛, 張陽, 李放, 等. Dynesys動態內固定與融合術治療L4/5單節段退變疾病的療效對比. 中國脊柱脊髓雜志, 2014, 20(10):873-878.
28.	楊峰, 何大為, 朱曉東, 等. Dynesys動態固定與腰椎融合固定治療腰椎退變性疾病的臨床比較研究. 第二軍醫大學學報, 2014, 35(10):1145-1150.
29.	陳博來, 林涌鵬, 許鴻智. Dynesys動態穩定系統與堅強固定治療單節段腰椎管狹窄癥對術后相鄰節段退變影響的比較. 廣東醫學, 2014, 35(4):553-555.
30.	彭超, 何智勇, 母建松, 等. Dynesys動態穩定系統置入內固定與后路腰椎間融合修復腰椎退行性病的比較. 中國組織工程研究, 2014, 18(44):7117-7121.
31.	汪凡棟, 鄭佳狀, 陳宇, 等. Dynesys 動態固定系統在腰椎退行性病變中的應用. 河北醫藥, 2015, 37(13):1948-1951.
32.	葉玉國, 伍驥, 鄭超, 等. L3~5節段退變性疾病融合與非融合術式的選擇. 安徽醫科大學學報, 2015, 50(3):364-367.
33.	包先國, 孫天勝, 侯景明, 等. Dynesys動態內固定與腰椎融合手術的對比分析. 南京醫科大學學報(自然科學版), 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.	梁春紅, 丁亮華, 吳采榮, 等. Dynesys動態穩定系統與腰椎退變性疾病. 國際骨科學雜志, 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.
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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. 龐曉東, 楊洪, 陳希霞, 等. Dynesys動態穩定系統治療腰椎多節段退變性疾病. 脊柱外科雜志, 2014, 12(1):11-14.
10. 劉園桐, 鎮萬新. Dynesys動態中和系統治療腰椎退行性疾病的研究近況. 中國矯形外科雜志, 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, 王飛, 等. 非融合技術與腰椎融合術治療腰椎退變性疾病的早期療效觀察. 臨床骨科雜志, 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. 衛沛然, 鄒德威, 陳曉明, 等. 后路減壓Dynesys動態固定與后路減壓融合內固定治療單節段腰椎退行性疾病的臨床療效的比較. 頸腰痛雜志, 2014, 35(2):90-95.
18. 丁國強, 李少波, 李炎, 等. 動態中和固定系統與后路椎間融合術治療退變性椎管狹窄的近期療效對比研究. 現代生物醫學進展, 2014, 14(31):6151-6155.
19. 李江龍, 劉繼波, 周鵬, 等. Dynesys動態中和系統和經后路椎間融合術治療腰椎退行性變的療效比較. 中國現代醫學雜志, 2014, 24(25):104-107.
20. 呂喬, 劉衛華, 程微, 等. Dynesys 動態內固定與融合術治療腰椎退變疾病的對比研究.河北醫藥, 2015, 21(4):603-605.
21. 黃鵬. 非融合動態內固定系統治療腰間盤突出伴腰椎不穩的療效研究. 醫學綜述, 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. 楊兵, 江庭彪. 動態中和系統與后路腰椎椎間融合治療腰椎退行性變的比較研究. 中國修復重建外科雜志, 2013, 27(2):140-144.
24. 樊友亮, 吳一雄, 胡輝東, 等. 經椎弓根動態穩定系統(Dynesys)與后路椎間融合治療腰椎管狹窄的臨床比較研究. 中國骨與關節損傷雜志, 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. 張陽, 李放, 單建林, 等. Dynesys動態內固定與融合術治療腰椎退變疾病的對比研究. 脊柱外科雜志, 2014, 12(1):19-24.
27. 肖進飛, 張陽, 李放, 等. Dynesys動態內固定與融合術治療L4/5單節段退變疾病的療效對比. 中國脊柱脊髓雜志, 2014, 20(10):873-878.
28. 楊峰, 何大為, 朱曉東, 等. Dynesys動態固定與腰椎融合固定治療腰椎退變性疾病的臨床比較研究. 第二軍醫大學學報, 2014, 35(10):1145-1150.
29. 陳博來, 林涌鵬, 許鴻智. Dynesys動態穩定系統與堅強固定治療單節段腰椎管狹窄癥對術后相鄰節段退變影響的比較. 廣東醫學, 2014, 35(4):553-555.
30. 彭超, 何智勇, 母建松, 等. Dynesys動態穩定系統置入內固定與后路腰椎間融合修復腰椎退行性病的比較. 中國組織工程研究, 2014, 18(44):7117-7121.
31. 汪凡棟, 鄭佳狀, 陳宇, 等. Dynesys 動態固定系統在腰椎退行性病變中的應用. 河北醫藥, 2015, 37(13):1948-1951.
32. 葉玉國, 伍驥, 鄭超, 等. L3~5節段退變性疾病融合與非融合術式的選擇. 安徽醫科大學學報, 2015, 50(3):364-367.
33. 包先國, 孫天勝, 侯景明, 等. Dynesys動態內固定與腰椎融合手術的對比分析. 南京醫科大學學報(自然科學版), 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. 梁春紅, 丁亮華, 吳采榮, 等. Dynesys動態穩定系統與腰椎退變性疾病. 國際骨科學雜志, 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.
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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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