Dynamic stabilization using the Dynesys system versus XXXX for the treatment of @entity179 : a clinical and radiological outcomes-based meta-analysis.

@entity1 @entity353 @entity2649 @entity190 @entity615 @entity179 @entity158 @entity1344 @entity528
OBJECTIVE The Dynesys, a @entity1344 ( @entity1344 ) system, was introduced to overcome the drawbacks of fusion procedures. Nevertheless, the theoretical advantages of @entity1344 over fusion have not been clearly confirmed. The aim of this study was to compare clinical and radiological outcomes of @entity1 who underwent @entity1344 using the Dynesys system with those who underwent @entity2649 ( @entity2649 ). METHODS The authors searched PubMed, Embase, Web of Science, and the Cochrane Database. Studies that reported outcomes of @entity1 who underwent @entity1344 or @entity2649 for the treatment of @entity179 were included. The primary efficacy end points were perioperative outcomes. The secondary efficacy end points were changes in the @entity615 visual analog scale (VAS) scores and in range of motion (ROM) at the treated and adjacent segments. A meta-analysis was performed to calculate @entity353 ( @entity353 ), 95% confidence intervals, Q statistics, and I(2) values. Forest plots were constructed for each analysis group. RESULTS Of the 274 retrieved articles, 7 (which involved 506 @entity1 [Dynesys, 250; @entity2649 , 256]) met the inclusion criteria. The Dynesys group showed a competitive advantage in mean surgery duration (20.73 minutes, 95% CI 8.76-32.70 minutes), @entity190 (81.87 ml, 95% CI 45.11-118.63 ml), and length of hospital stay (1.32 days, 95% CI 0.23-2.41 days). Both the Dynesys and @entity2649 groups experienced improved ODI and VAS scores after 2 years of follow-up. Regarding the ODI and VAS scores, no statistically significant difference was noted according to surgical procedure (ODI: WMD 0.12, 95% CI -3.48 to 3.72; back @entity158 VAS score: WMD -0.15; 95% CI -0.56 to 0.26; leg @entity158 VAS score: WMD -0.07; 95% CI -0.47 to 0.32). The mean ROM at the adjacent segment increased in both groups, and there was no substantial difference between them (WMD 1.13; 95% CI -0.33 to 2.59). Although the United States is the biggest market for Dynesys, no eligible study from the United States was found, and 4 of 8 enrolled studies were performed in China. The results must be interpreted with caution because of publication bias. During Dynesys implantation, surgeons have to decide the length of the spacer and cord pretension. These values are debatable and can vary according to the surgeon's experience and the @entity1 's condition. Differences between the surgical procedures were not considered in this study. CONCLUSIONS Fusion still remains the method of choice for @entity528 and gross instability. However, @entity179 with or without Grade I spondylolisthesis, particularly in @entity1 who require a quicker recovery, will likely constitute the main indication for @entity1344 using the Dynesys system.
