A clinical case of the intervertebral disc rehydration after dynamic transpedicular fixation using nitinol rods

Abstract

Introduction. The clinical case of a patient with a generalized degenerative lesion of the lumbar spine in combination with clinical and radiological signs of the adjacent disk syndrome is presented in the article.

Materials and methods. The patient turned to the neurosurgical department of the Research Center of Neurology with complaints of low back pain with irradiation on the external surface of the left leg, and numbness in this area. In the anamnesis: microsurgical removal of the HIVD at the levels L4–L5 and L5–S1. According to magnetic resonance imaging (MRI), a disc herniation and according to functional radiography – signs of instability were revealed at the level of L3–L4. In order to prevent further progression of the degenerative cascade, the patient underwent surgical intervention – dynamic transpedicular fixation with nitinol rods, a metal with shape memory effect. At pre- and postoperative periods we performed clinical evaluation (VAS pain scale, Oswestry quality of life assessment, modified Macnub scale), MRI of the lumbar spine (an analysis of the fixed and adjacent segments degeneration extent according to Pfirman classification), and functional radiography (estimation of the range of motion in the fixed and adjacent segments).

Results. We observed a significant reduction in back pain, a complete regression of leg pain and an improvement in the quality of life compared to the preoperative level. Twelve months after the surgery, on the MRI scan we observed signs of rehydration and regeneration on a fixed segment and the absence of acceleration of degeneration on adjacent segments

About the authors

Ekaterina N. Poltorako

Research Center of Neurology, Moscow

Author for correspondence.
Email: platonova@neurology.ru
Russian Federation

Artem O. Gushcha

Research Center of Neurology, Moscow

Email: platonova@neurology.ru
Russian Federation

Maxim D. Dreval

Research Center of Neurology, Moscow

Email: platonova@neurology.ru
Russian Federation

Alexey A. Kascheev

Research Center of Neurology, Moscow

Email: platonova@neurology.ru
Russian Federation

Sergey O. Arestov

Research Center of Neurology, Moscow

Email: platonova@neurology.ru
Russian Federation

Andrey V. Vershinin

Research Center of Neurology, Moscow

Email: platonova@neurology.ru
Russian Federation

References

  1. Zhao C.Q., Wang L.M., Jiang L.S., Dai L.Y. The cell biology of intervertebral disc aging and degeneration. Ageing Res Rev 2007; 6: 247–261. doi: 10.1016/j.arr.2007.08.001. PMID: 17870673.
  2. Hickey D.S., Hukins D.W. X-ray diffraction studies of the arrangement of collagenous fibres in human fetal intervertebral disc. J Anat 1980; 131: 81–90.PMID: 7440405.
  3. Hukins D.W. A simple model for the function of proteoglycans and collagen in the response to compression of the intervertebral disc. Proc Biol Sci 1992; 249: 281–285. doi: 10.1098/rspb.1992.0115. PMID: 1359558.
  4. Sengupta D.K., Herkowitz H.N. Pedicle screw-based posterior dynamic stabilization: literature review. Adv Orthop 2012: 424268. doi: 10.1155/2012/424268. PMID: 23227349.
  5. Lyons G., Eisenstein S.M., Sweet M.B. Biochemical changes in intervertebral disc degeneration. Biochim Biophys Acta 1981; 673: 443–453. PMID: 7225426.
  6. Coppes M.H., Marani E., Thomeer R.T., Groen G.J. Innervation of “painful” lumbar discs. Spine (Phila Pa 1976) 1997; 22: 2342–2349. PMID: 9355214.
  7. Kasra M., Goel V., Martin J. et al. Effect of dynamic hydrostatic pressure on rabbit intervertebral disc cells. J Orthop Res 2003; 21: 597–603. doi: 10.1016/S0736-0266(03)00027-5. PMID: 12798057.
  8. Haughton V. Medical imaging of intervertebral disc degeneration: current status of imaging. Spine (Phila Pa 1976) 2004; 29: 2751–2756.
  9. Lotz J.C., Chin J.R. Intervertebral disc cell death is dependent on the magnitudeand duration of spinal loading. Spine (Phila Pa 1976) 2000; 25: 1477–1483. PMID: 10851095.
  10. Cho B.Y., Murovic J., Park K.W., Park J. Lumbar disc rehydration postimplantationof a posterior dynamic stabilization system. J Neurosurg Spine 2010;13: 576–580. doi: 10.3171/2010.5.SPINE08418. PMID: 21039146.
  11. Guehring T., Omlor G.W., Lorenz H. et al. Disc distraction shows evidence of regenerative potential in degenerated intervertebral discs as evaluated by protein expression, magnetic resonance imaging, and messenger ribonucleic acid expression
  12. analysis. Spine (Phila Pa 1976) 2006; 31: 1658–1665. doi: 10.1097/01.brs.0000224558.81765.56. PMID: 16816759.
  13. Schnake K.J., Putzier M., Haas N.P., Kandziora F. Mechanical concepts for disc regeneration. Eur Spine J 2006; 15 (Suppl 3): S354–S360. DOI: 10.1007/ s00586-006-0176-y. PMID: 16835733.
  14. Sengupta D.K., Mulholland R.C. Fulcrum assisted soft stabilization system: a new concept in the surgical treatment of degenerative low back pain. Spine (Phila Pa 1976) 2005; 30: 1019–1029. PMID: 15864153.
  15. Carragee E.J., Han M.Y., Suen P.W., Kim D. Clinical outcomes after lumbar discectomy for sciatica: the effects of fragment type and anular competence. JBone Joint Surg Am 2003; 85-A(1): 102–108. PMID: 12533579.
  16. Pfirrmann C.W., Metzdorf A., Zanetti M., Hodler J., Boos N. Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa1976) 2001; 26: 1873–1878. PMID: 11568697.
  17. Wiltse L.L., Spencer C.W. New uses and refinements of the paraspinal ap- proach to the lumbar spine. Spine (Phila Pa 1976) 1988; 13(6): 696–706. PMID: 3175760.
  18. Urban J.P., Roberts S. Degeneration of the intervertebral disc. Arthritis Res Ther 2003; 5: 120–130. PMID: 12723977.
  19. Adams M.A., McNally D.S., Dolan P. ‘Stress’ distributions inside intervertebraldiscs: the effects of age and degeneration. J Bone Joint Surg Br 1996; 78:965–792. PMID: 8951017.
  20. Freemont A.J., Peacock T.E., Goupille P. et al. Nerve ingrowth into diseased intervertebral disc in chronic back pain. Lancet 1997; 350: 178–181. PMID: 9250186.
  21. Kroeber M., Unglaub F., Guehring T. et al. Effects of controlled dynamic disc distraction on degenerated intervertebral discs: an in vivo study on the rabbit lumbar spine model. Spine (Phila Pa 1976) 2005; 30: 181–187. PMID: 15644753.
  22. Urban J.P., Smith S., Fairbank J.C. Nutrition of the intervertebral disc. Spine (Phila Pa 1976) 2004; 29: 2700–2709. PMID: 15564919.
  23. Bono C.M., Kadaba M., Vaccaro A.R. Posterior pedicle fixation-baseddynamic stabilization devices for the treatment of degenerative diseases of the lumbar spine. J Spinal Disord Tech 2009; 22: 376–383. doi: 10.1097/BSD.0b013e31817c6489. PMID: 19525796.
  24. Schmoelz W., Huber J.F., Nydegger T. et al. Influence of a dynamic stabilization system on load bearing of a bridged disc: an in vitro study of intradiscal pressure. Eur Spine J 2006; 15: 1276–1285. PMID: 16429291.
  25. Ozer A.F., Crawford N.R., Sasani M. et al. Dynamic lumbar pedicle screwrod stabilization: two-year follow-up and comparison with fusion. Open Orthop J 2010; 4: 137–141. doi: 10.2174/1874325001004010137. PMID: 20448815.
  26. Kumar A., Beastall J., Hughes J. et al. Disc changes in the bridged and adjacent segments after Dynesys dynamic stabilization system after two years. Spine (Phila Pa 1976) 2008; 33: 2909–2914. doi: 10.1097/BRS.0b013e31818bdca7. PMID: 19092623.
  27. Kaner T., Ozer A.F. Dynamic stabilization for challenging lumbar degenerative diseases of the spine: a review of the literature. Adv Orthop 2013; 2013: 753470. doi: 10.1155/2013/753470. PMID: 23662211.
  28. Putzier M., Schneider S.V., Funk J.F. et al. The surgical treatment of the lumbar disc prolapse: nucleotomy with additional transpedicular dynamic stabilization versus nucleotomy alone. Spine (Phila Pa 1976) 2005; 30: E109–E114. PMID: 15738772.
  29. Schnake K.J., Schaeren S., Jeanneret B. Dynamic stabilization in addition to decompression for lumbar spinal stenosis with degenerative spondylolisthesis. Spine (Phila Pa 1976) 2006; 31: 442–449. PMID: 16481955. 29. Mulholland R.C., Sengupta D.K. Rationale, principles and experimental evaluation of the concept of soft stabilization. Eur Spine J 2002; 11 (Suppl. 2): S198–S205. doi: 10.1007/s00586-002-0422-x. PMID: 12384745.
  30. Bordes-Monmeneu M., Bordes-Garcia V., Rodrigo-Baeza F., Saez D. System of dynamic neutralization in the lumbar spine: experience on 94 cases. Neurocirugia(Astur) 2005; 16: 499–506. PMID: 16378132

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Copyright (c) 2018 Poltorako E.N., Gushcha A.O., Dreval M.D., Kascheev A.A., Arestov S.O., Vershinin A.V.

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