STUDY DESIGN: Retrospective clinical cohort study. PURPOSE: To investigate whether the combined use of dynamic pedicle screws and polyaxial pedicle screws was effective on adjacent segment pathology (ASP). OVERVIEW OF LITERATURE: Various screw and rod models have been recently developed for preventing adjacent segment disease, and hybrid systems have been described along with posterior instrumentation in the fusion segment. In the literature, although the success of dynamic systems has been demonstrated in non-fusion posterior instrumentation, it remains unclear whether the addition of a screw-based dynamic system to a fusion segment would successfully prevent ASP in the long term. METHODS: The study included 101 patients who underwent surgery for degenerative spine diseases between 2007 and 2014 with lumbar stabilization that used either polyaxial pedicle screws alone or polyaxial pedicle screws plus dynamic stabilization screws (with hinged screw heads). These two patient groups were compared using retrospectively obtained postoperative new clinical findings, Oswestry disability index (ODI) scores, visual analog scale (VAS) scores, and radiological data. RESULTS: The proportion of patients with ASP who were radiologically assessed was low (p <0.01) in the group that underwent lumbar stabilization along with dynamic screws. Treatment outcomes were clinically successful in both groups according to ODI and VAS scores, and no significant difference was determined between the groups in terms of clinical ASP (p >0.05). CONCLUSIONS: Although the combined use of dynamic screws and the static system was radiologically found to be effective for preventing ASP in patients who underwent lumbar fusion with posterior instrumentation, it did not completely eliminate ASP or result in a significant improvement in clinical ASP.
Cohort Studies ; Humans ; Pathology* ; Pedicle Screws* ; Retrospective Studies ; Spine* ; Viperidae ; Visual Analog Scale

STUDY DESIGN: Eighty-four patients who had been treated for degenerative spinal diseases between January 2006 and June 2009 were reviewed retrospectively. PURPOSE: We aimed to compare the clinical and radiologic findings of manual workers who underwent posterolateral fusion (PLF) or posterior interbody fusion (PLIF) involving fusion of 3 or more levels of the spine. OVERVIEW OF LITERATURE: Previous studies have concluded that there is no significant difference between the clinical outcome of PLF and PLIF techniques. METHODS: After standard decompression, 42 patients underwent PLF and the other 42 patients underwent PLIF. Radiologic findings, Oswestry disability index (ODI) scores, and visual analogue scale (VAS) scores were assessed preoperatively and at 6-month intervals postoperatively and return to work times/rates were assessed for 48 months. RESULTS: Patients who underwent PLF had significantly shorter surgical time and less blood loss. According to the 48-month clinical results, ODI and VAS scores were reduced significantly in the two groups, but the PLIF group showed better results than the PLF group at the last follow-up. Return to work rate was 63% in the PLF group and 87% in the PLIF group. Union rates were found to be 81% and 89%, respectively, after 24 months (p=0.154). CONCLUSIONS: PLIF is a preferable technique with respect to stability and correction, but the result does not depend on only the fusion rates. Discectomy and fusion mass localization should be considered for achieving clinical success with the fusion technique. Before performing PLIF, the association of the long operative time and high blood loss with mortality and morbidity should be taken into consideration, particularly in the elderly and disabled patients.
Aged ; Decompression ; Diskectomy ; Follow-Up Studies ; Humans ; Mortality ; Operative Time ; Retrospective Studies ; Return to Work ; Scoliosis ; Spinal Diseases ; Spine