Re-Evaluating the Long-Term Efficacy of Semi-Rigid Fixation Using a Nitinol Spring Rod in Lumbar Surgery: A Retrospective Study on an Effective Alternative for Reducing Adjacent Segment Disease

Abstract

Adjacent segment disease (ASD) is a prevalent complication following lumbar fusion surgery, representing a significant challenge in spinal surgery. This study aimed to assess the long-term outcomes of Nitinol spring rod semi-rigid fixation, a potential alternative to traditional rigid fixation, in reducing the incidence of ASD. This retrospective case study evaluated 89 patients who underwent lumbar or lumbosacral surgeries using a combination of Bioflex (R) (a Nitinol spring rod dynamic stabilization system) and an interbody cage over 10 years of follow-up. The fusion status, adjacent segment disc height, mechanical complications, and re-operation rates were analyzed. The cohort had a median follow-up duration of 13.0 years. All patients achieved solid fusion at the final follow-up visit. One patient underwent revision surgery for clinical ASD (1.1%), and no patients required revision surgery due to mechanical problems. Radiological evidence of ASD was observed in 16.9% of the patients. This study's findings suggest that semi-rigid fixation using Bioflex with an interbody cage is a possibly effective treatment strategy to prevent ASD. The technique potentially reduces the risk of ASD by allowing a degree of movement at the surgical site.