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J Neurol Surg A Cent Eur Neurosurg 2018; 79(03): 224-230
DOI: 10.1055/s-0037-1615264
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Dynamic Posterior Stabilization versus Posterior Lumbar Intervertebral Fusion: A Matched Cohort Study Based on the Spine Tango Registry

Kathrin S. Bieri
1   SwissRDL, Universitat Bern Institut fur Sozial- und Praventivmedizin, Bern, BE, Switzerland
,
Kelly Goodwin
1   SwissRDL, Universitat Bern Institut fur Sozial- und Praventivmedizin, Bern, BE, Switzerland
,
Emin Aghayev
2   Department of Research and Development, Schulthess Klinik, Zurich, ZH, Switzerland
,
Hans-Joachim Riesner
3   Department of Traumatology and Orthopaedics, Military Hospital, Ulm, Germany
,
Ralph Greiner-Perth
4   Department of Spine, Centre for Orthopaedics and Neurosurgery, Hof, Germany
› Author Affiliations
Further Information

Publication History

10 July 2017

25 September 2017

Publication Date:
18 January 2018 (online)

Also available ateRefMedOne
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Abstract

Purpose The primary aim of dynamic stabilization is to stabilize the spine and preserve function without overstressing adjacent segments, which is a potential risk of fusion surgery. However, direct comparative analyses of the two approaches are still limited, and little is known about the association of patient-reported outcomes with these treatment options.

Objective To compare the clinical outcomes of dynamic posterior stabilization using the DSS Stabilization System (Paradigm Spine, LLC, New York, New York, United States) versus posterior lumbar intervertebral fusion (PLIF) based on data from a spine registry. We hypothesized that patient-reported outcomes of DSS are not inferior to those of PLIF.

Methods We identified 202 DSS and 269 PLIF patients with lumbar degenerative disease with a minimum 2-year follow-up. A 1:1 propensity score–based matching was applied to balance the groups for various patient characteristics. The primary outcome was the change in the patient-reported Core Outcome Measures Index (COMI; a 0–10 scale) score.

Results The matching resulted in 77 DSS-PLIF pairs (mean age: 67 years; average COMI follow-up: 3.3 years) without residual significant differences in baseline characteristics. The groups showed no difference in improved COMI score (p = 0.69), as well as in back (p = 0.51) and leg pain relief (p = 0.56), blood loss (p = 0.12), and complications (p > 0.15). Fewer repeat surgeries occurred after DSS (p = 0.01). The number of repeat surgeries per 100 observed person-years was 0.8 and 2.9 in DSS and in PLIF patients, respectively. Furthermore, shorter surgery time (p < 0.001) and longer hospital stays (p = 0.03) were observed for DSS cases.

Conclusion In a midterm perspective, DSS may be a viable alternative to PLIF because both therapies result in similar COMI score improvement. Advantages of DSS may be shorter duration of surgery and fewer repeat surgeries. However, more than half of DSS patients did not find a match with a PLIF patient, suggesting that the patient profiles may be different. Further multicenter studies are needed to better understand the most appropriate indication for each therapy.

Keywords

dynamic stabilization - fusion - degenerative spine disease - propensity score-based matching - registry