Could the Topping-Off Technique Be the Preventive Strategy against Adjacent Segment Disease after Pedicle Screw-Based Fusion in Lumbar Degenerative Diseases? A Systematic Review

Table 1

Clinical reported hybrid stabilization device and interspinous process device in the lumbar degenerative surgery.

Authors,; years

Implant type

Study (level of evidence)

Patients numbers

Mean F/u (months)

Min. F/u (months)

Max. F/u (months)

Indications for index level instrumentation

Exclusion criteria for the study

Fused vertebrae numbers

Level for dynamic device

Reported radiographic outcomes

Reported clinical outcomes

Hybrid stabilization device (HSD)

Formica et al. [13], 2015

CD HORIZON BalanC™ System (Medtronic Minnesota, USA)

Retrospective series cases (IV)

38

24

24

24

Pfirrmann I to III

(1) Idiopathic or deg. scoliosis; (2) Gr. 3-4 listhesis; (3) Failed back syndrome; (4) Sagittal imbalance (LL < PI-5°); (5) BMI > 35; (6) Clinical contraindication to

2

L23; L34; L45

X-ray; (DH/VBH); MRI; (Pfirrmann)

VAS; (back, leg); ODI

Putzier et al. [14], 2010

Allo Spine™ Dynesys Transition System (Zimmer, Winterthur, Switzerland)

Prospective randomized, nonblind comparative (II)

22

76.4

60

91

Asymptomatic but radiographic DD (Modic grade I)

(1) Symptomatic proved by discography; (2) Positive disc analgesia; (3) Severe facet joints arthropathy; (4) Spine deformity; (5) Destructive process; (6) Previous surgery

2

L34; L45

MRI (Modic)

VAS (back); ODI

Imagama et al. [15], 2009

Natural Neutral Concept Rod (Howa Co. Ltd.)

Retrospective comparative (III)

35

42

NA

NA

No instability

(1) ≧4 mm listhesis at L3; (2) Severe DD at L34 (Pfirrmann’s V); (3) Deg. scoliosis ≧ 10°(4) Severe instability

2

L34

X-ray (middle DH) MRI (Pfirrmann)

JOA score

Interspinous process device (IPD)

Lu et al. [16], 2015

DIAM (Device for Intervertebral Assisted Motion) (Medtronic Sofamor Danek)

Retrospective (III)

49

41.2

24

48

(1) DH 50% with/without segmental F/E mobility; (2) No segmental F/E mobility and the status of the discs was suitable

NA

4

L12; L23; L34

MRI (Pfirrmann)

VAS (back, leg); ODI

Lee et al. [17], 2013

DIAM (Device for Intervertebral Assisted Motion) (Medtronic Sofamor Danek)

Retrospective (III)

25

46.8

24

97

(1) Pfirrmann Gr. II-III; (2) MRI: facet deg. or effusion; (3) Mild to moderate spinal or foraminal stenosis

NA

2

L23; L34; L45

X-ray (FH)

VAS (back, leg); ODI

Korovessis et al. [18], 2009

Wallis

Prospective controlled (II)

24

60

NA

NA

(1) UCLA Gr. I or II (no listhesis or lytic lesion); (2) Degenerative (listhesis spinal stenosis, loss of segmental lordosis); (3) 2 to 4 vertebral fusions

(1) Severe osteoporosis; (2) Loss lumbar lordosis; (3) Previous lumbar surgery (fracture); (4) Ankylosis; (5) UCLA > II in index level; (6) Spinous process insufficiency

3.5

NA

X-ray (ant./post. DH) (UCLA)

VAS (back); ODI; SF-36

NA: not available, min.: minimum, max.: maximum, f/u: follow-up, PSs: pedicle screws, FH: foraminal height, ant.: anterior, post.: posterior, deg.: degenerative, F/E: flexion/extension, ASD: adjacent segment disease, ODI: Oswestry Disability Index, VAS: visual analogue scale, JOA: Japanese Orthopaedic Association, DH: disc height, and VBH: vertebral body height.
clinical contraindications were including (1) long-term medication of steroid or NSAID (chronic pain Gerbershagen Gr. 2); (2) liver or kidney diseases; (3) malignant tumor; (4) pregnancy; (5) chronic nicotine, alcohol, or drug abuse.