A minimum 8-year follow-up comparative study of decompression and coflex stabilization with decompression and fusion

Abstract

The current study aimed to compare the outcomes of decompression and interlaminar stabilisation with those of decompression and fusion for the treatment of lumbar degenerative disease (LDD) at a minimum 8-year follow-up. The current study also aimed to analyse the risk factors of radiographic adjacent segment degeneration (ASD). A total of 82 consecutive patients with LDD who underwent surgery between June 2007 and February 2011 were retrospectively reviewed. Of these patients, 39 underwent decompression and Coflex interspinous stabilisation (Coflex group) and 43 underwent decompression and posterior lumbar interbody fusion (PLIF) (PLIF group). All patients had a minimum of 8-years of follow-up data. Radiographic and clinical outcomes were compared between the groups, and the risk factors of developing radiographic ASD were also evaluated. The Oswestry disability index and visual analogue scale leg and back pain scores of both groups significantly improved compared with the baseline (all P<0.05), and no difference were indicated between the two groups at each follow-up time point (P>0.05). The Coflex group exhibited preserved mobility (P<0.001), which was associated with a decreased amount of blood loss (P<0.001), shorter duration of surgery (P=0.001), shorter duration of hospital stay and a lower incidence of ASD (12.8 vs. 32.56%; P=0.040) compared with the fusion group. The current study indicated that coflex and fusion technologies are safe and effective for the treatment of LDD, based on long-term follow-up data. However, Coflex interspinous stabilisation was revealed to reduce ASD incidence. Under strict indications, Coflex interspinous stabilisation is an effective and safe treatment method.

Keywords: adjacent segment degeneration; decompression; fusion; interlaminar stabilisation; lumbar degenerative disease.

Figure 1

Radiological indices are presented at lateral views. a, Posterior disc height. b, Foraminal height. α, intervertebral angle (range of motion = extension α - flexion α); d, line of inferior margin of upper vertebrae; f, line of superior margin of lower vertebral.

Figure 2

Clinical outcomes and radiologic outcomes. All data are presented as the means ± standard deviation. A t-test was used to compare all clinical and radiographic data. (A) Foraminal height. (B) Posterior disc height. (C) ROM of the operated segment. (D) ROM of the upper adjacent segment. (E) ROM of the lower adjacent segment. (F) ODI score. (G) VAS back pain score. (H) VAS leg pain score. ROM, range of motion. ODI, Oswestry disability index; VAS, visual analogue scale; FU, follow-up.

Figure 3

(A) Preoperative X-ray. (B-C) Preoperative MRI indicates LDD at L4-5 (red arrow). (D-E) One year postoperatively. (F) MRI indicates ASD in lower adjacent segment at the final follow-up. ASD, adjacent segment degeneration; LDD, lumbar degenerative disease.