{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T09:07:33Z","timestamp":1779527253115,"version":"3.53.1"},"reference-count":46,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2016,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>The development of symptomatic adjacent-segment disease (ASD) is a well-recognized consequence of lumbar fusion surgery. Extension of a fusion to a diseased segment may only lead to subsequent adjacent-segment degeneration. The authors report the use of a novel technique that uses dynamic stabilization instead of arthrodesis for the surgical treatment of symptomatic ASD following a prior lumbar instrumented fusion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A cohort of 28 consecutive patients was evaluated who developed symptomatic stenosis immediately adjacent to a previous lumbar instrumented fusion. All patients had symptoms of neurogenic claudication refractory to nonsurgical treatment and were surgically treated with decompression and dynamic stabilization instead of extending the fusion construct using a posterior lumbar dynamic stabilization system. Preoperative symptoms, visual analog scale (VAS) pain scores, and perioperative complications were recorded. Clinical outcome was gauged by comparing VAS scores prior to surgery and at the time of last follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>The mean follow-up duration was 52 months (range 17\u201394 months). The mean interval from the time of primary fusion surgery to the dynamic stabilization surgery was 40 months (range 10\u201396 months). The mean patient age was 51 years (range 29\u201376 years). There were 19 (68%) men and 9 (32%) women. Twenty-three patients (82%) presented with low-back pain at time of surgery, whereas 24 patients (86%) presented with lower-extremity symptoms only. Twenty-four patients (86%) underwent operations that were performed using single-level dynamic stabilization, 3 patients (11%) were treated at 2 levels, and 1 patient underwent 3-level decompression and dynamic stabilization. The most commonly affected and treated level (46%) was L3\u20134. The mean preoperative VAS pain score was 8, whereas the mean postoperative score was 3. No patient required surgery for symptomatic degeneration rostral to the level of dynamic stabilization during the follow-up period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>The use of posterior lumbar dynamic stabilization may offer a valid and safe option for the management of patients who develop ASD rostral to a previously instrumented arthrodesis. The technique may serve as an alternative to multilevel arthrodesis in this patient population. By implanting a dynamic stabilization device instead of an extension of a rigid construct, this might translate into a reduction in the development of yet another level of ASD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2015.10.focus15413","type":"journal-article","created":{"date-parts":[[2016,1,1]],"date-time":"2016-01-01T03:36:37Z","timestamp":1451619397000},"page":"E5","source":"Crossref","is-referenced-by-count":9,"title":["Posterior lumbar dynamic stabilization instead of arthrodesis for symptomatic adjacent-segment degenerative stenosis: description of a novel technique"],"prefix":"10.3171","volume":"40","author":[{"given":"Hazem","family":"Mashaly","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania; and"},{"name":"Department of Neurological Surgery, Ain Shams University, Cairo, Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin E.","family":"Paschel","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas K.","family":"Khattar","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ezequiel","family":"Goldschmidt","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter C.","family":"Gerszten","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-focus15413","series-title":"Acta Orthop Scand","first-page":"309","article-title":"Posterolateral lumbar fusion. Outcome of 71 consecutive operations after 4 (2\u20137) years","volume":"65","author":"Axelsson","year":"1994"},{"key":"b2-focus15413","series-title":"J Spinal Disord Tech","first-page":"376","article-title":"Posterior pedicle fixation-based dynamic stabilization devices for the treatment of degenerative diseases of the lumbar spine","volume":"22","author":"Bono","year":"2009"},{"key":"b3-focus15413","series-title":"Spine (Phila Pa 1976)","first-page":"455","article-title":"Critical analysis of trends in fusion for degenerative disc disease over the past 20 years: influence of technique on fusion rate and clinical outcome","volume":"29","author":"Bono","year":"2004"},{"key":"b4-focus15413","series-title":"J Neurosurg Spine","first-page":"380","article-title":"Adjacent-segment disease in 511 cases of posterolateral instrumented lumbar arthrodesis: floating fusion versus distal construct including the sacrum","volume":"20","author":"Bydon","year":"2014"},{"key":"b5-focus15413","series-title":"Spine (Phila Pa 1976)","first-page":"2253","article-title":"Adjacent segment disease following lumbar\/thoracolumbar fusion with pedicle screw instrumentation: a minimum 5-year follow-up","volume":"32","author":"Cheh","year":"2007"},{"key":"b6-focus15413","series-title":"Spine (Phila Pa 1976)","first-page":"2551","article-title":"Immediate biomechanical effects of lumbar posterior dynamic stabilization above a circumferential fusion","volume":"32","author":"Cheng","year":"2007"},{"key":"b7-focus15413","series-title":"Arch Orthop Trauma Surg","first-page":"39","article-title":"Adjacent segment degeneration after lumbar spinal posterolateral fusion with instrumentation in elderly patients","volume":"122","author":"Chou","year":"2002"},{"issue":"2 Suppl","key":"b8-focus15413","series-title":"J Neurosurg","first-page":"163","article-title":"Risk factors for adjacent-segment failure following lumbar fixation with rigid instrumentation for degenerative instability","volume":"90","author":"Etebar","year":"1999"},{"key":"b9-focus15413","series-title":"Spine J","first-page":"342","article-title":"Update on the evidence for adjacent segment degeneration and disease","volume":"13","author":"Helgeson","year":"2013"},{"key":"b10-focus15413","series-title":"J Spinal Disord Tech","first-page":"60","article-title":"Comparisons of outcomes after single or multilevel dynamic stabilization: effects on adjacent segment","volume":"24","author":"Kim","year":"2011"},{"key":"b11-focus15413","series-title":"Spine (Phila Pa 1976)","first-page":"574","article-title":"Lumbosacral spinal fusion. A biomechanical study","volume":"9","author":"Lee","year":"1984"},{"key":"b12-focus15413","series-title":"J Korean Neurosurg Soc","first-page":"221","article-title":"Clinical experience of the dynamic stabilization system for the degenerative spine disease","volume":"43","author":"Lee","year":"2008"},{"issue":"6","key":"b13-focus15413","series-title":"Neurosurg Focus","first-page":"E2","article-title":"The use of a hybrid dynamic stabilization and fusion system in the lumbar spine: preliminary experience","volume":"28","author":"Maserati","year":"2010"},{"key":"b14-focus15413","series-title":"Eur Spine J","first-page":"913","article-title":"Biomechanical characterization of the three-dimensional kinematic behaviour of the Dynesys dynamic stabilization system: an in vitro study","volume":"15","author":"Niosi","year":"2006"},{"issue":"16 Suppl","key":"b15-focus15413","series-title":"Spine (Phila Pa 1976)","first-page":"S68","article-title":"Dynamic stabilization in the surgical management of painful lumbar spinal disorders","volume":"30","author":"Nockels","year":"2005"},{"key":"b16-focus15413","series-title":"Spine (Phila Pa 1976)","first-page":"1535","article-title":"Risk factors for adjacent segment degeneration after PLIF","volume":"29","author":"Okuda","year":"2004"},{"key":"b17-focus15413","series-title":"Spine (Phila Pa 1976)","first-page":"1938","article-title":"Adjacent segment disease after lumbar or lumbosacral fusion: review of the literature","volume":"29","author":"Park","year":"2004"},{"key":"b18-focus15413","series-title":"Eur Spine J","first-page":"2181","article-title":"Dynamic stabilization adjacent to single-level fusion: part II. No clinical benefit for asymptomatic, initially degenerated adjacent segments after 6 years follow-up","volume":"19","author":"Putzier","year":"2010"},{"key":"b19-focus15413","series-title":"Spine (Phila Pa 1976)","first-page":"E636","article-title":"Minimum four-year follow-up of spinal stenosis with degenerative spondylolisthesis treated with decompression and dynamic stabilization","volume":"33","author":"Schaeren","year":"2008"},{"key":"b20-focus15413","series-title":"J Spinal Disord Tech","first-page":"418","article-title":"Dynamic stabilization of the lumbar spine and its effects on adjacent segments: an in vitro experiment","volume":"16","author":"Schmoelz","year":"2003"},{"key":"b21-focus15413","series-title":"Spine (Phila Pa 1976)","first-page":"442","article-title":"Dynamic stabilization in addition to decompression for lumbar spinal stenosis with degenerative spondylolisthesis","volume":"31","author":"Schnake","year":"2006"},{"key":"b22-focus15413","series-title":"Eur Spine J","first-page":"2171","article-title":"Dynamic stabilization adjacent to single-level fusion: part I. Biomechanical effects on lumbar spinal motion","volume":"19","author":"Strube","year":"2010"},{"key":"b23-focus15413","series-title":"Turk Neurosurg","first-page":"579","article-title":"Can posterior dynamic stabilization reduce the risk of adjacent segment deterioration?","volume":"23","author":"Zhou","year":"2013"},{"key":"b1-focus15413","series-title":"Acta Orthop Scand","first-page":"309","article-title":"Posterolateral lumbar fusion. Outcome of 71 consecutive operations after 4 (2\u20137) years","volume":"65","author":"Axelsson","year":"1994"},{"key":"b2-focus15413","series-title":"J Spinal Disord Tech","first-page":"376","article-title":"Posterior pedicle fixation-based dynamic stabilization devices for the treatment of degenerative diseases of the lumbar spine","volume":"22","author":"Bono","year":"2009"},{"key":"b3-focus15413","series-title":"Spine (Phila Pa 1976)","first-page":"455","article-title":"Critical analysis of trends in fusion for degenerative disc disease over the past 20 years: influence of technique on fusion rate and clinical outcome","volume":"29","author":"Bono","year":"2004"},{"key":"b4-focus15413","series-title":"J Neurosurg Spine","first-page":"380","article-title":"Adjacent-segment disease in 511 cases of posterolateral instrumented lumbar arthrodesis: floating fusion versus distal construct including the sacrum","volume":"20","author":"Bydon","year":"2014"},{"key":"b5-focus15413","series-title":"Spine (Phila Pa 1976)","first-page":"2253","article-title":"Adjacent segment disease following lumbar\/thoracolumbar fusion with pedicle screw instrumentation: a minimum 5-year follow-up","volume":"32","author":"Cheh","year":"2007"},{"key":"b6-focus15413","series-title":"Spine (Phila Pa 1976)","first-page":"2551","article-title":"Immediate biomechanical effects of lumbar posterior dynamic stabilization above a circumferential fusion","volume":"32","author":"Cheng","year":"2007"},{"key":"b7-focus15413","series-title":"Arch Orthop Trauma Surg","first-page":"39","article-title":"Adjacent segment degeneration after lumbar spinal posterolateral fusion with instrumentation in elderly patients","volume":"122","author":"Chou","year":"2002"},{"issue":"2 Suppl","key":"b8-focus15413","series-title":"J Neurosurg","first-page":"163","article-title":"Risk factors for adjacent-segment failure following lumbar fixation with rigid instrumentation for degenerative instability","volume":"90","author":"Etebar","year":"1999"},{"key":"b9-focus15413","series-title":"Spine J","first-page":"342","article-title":"Update on the evidence for adjacent segment degeneration and disease","volume":"13","author":"Helgeson","year":"2013"},{"key":"b10-focus15413","series-title":"J Spinal Disord Tech","first-page":"60","article-title":"Comparisons of outcomes after single or multilevel dynamic stabilization: effects on adjacent segment","volume":"24","author":"Kim","year":"2011"},{"key":"b11-focus15413","series-title":"Spine (Phila Pa 1976)","first-page":"574","article-title":"Lumbosacral spinal fusion. A biomechanical study","volume":"9","author":"Lee","year":"1984"},{"key":"b12-focus15413","series-title":"J Korean Neurosurg Soc","first-page":"221","article-title":"Clinical experience of the dynamic stabilization system for the degenerative spine disease","volume":"43","author":"Lee","year":"2008"},{"issue":"6","key":"b13-focus15413","series-title":"Neurosurg Focus","first-page":"E2","article-title":"The use of a hybrid dynamic stabilization and fusion system in the lumbar spine: preliminary experience","volume":"28","author":"Maserati","year":"2010"},{"key":"b14-focus15413","series-title":"Eur Spine J","first-page":"913","article-title":"Biomechanical characterization of the three-dimensional kinematic behaviour of the Dynesys dynamic stabilization system: an in vitro study","volume":"15","author":"Niosi","year":"2006"},{"issue":"16 Suppl","key":"b15-focus15413","series-title":"Spine (Phila Pa 1976)","first-page":"S68","article-title":"Dynamic stabilization in the surgical management of painful lumbar spinal disorders","volume":"30","author":"Nockels","year":"2005"},{"key":"b16-focus15413","series-title":"Spine (Phila Pa 1976)","first-page":"1535","article-title":"Risk factors for adjacent segment degeneration after PLIF","volume":"29","author":"Okuda","year":"2004"},{"key":"b17-focus15413","series-title":"Spine (Phila Pa 1976)","first-page":"1938","article-title":"Adjacent segment disease after lumbar or lumbosacral fusion: review of the literature","volume":"29","author":"Park","year":"2004"},{"key":"b18-focus15413","series-title":"Eur Spine J","first-page":"2181","article-title":"Dynamic stabilization adjacent to single-level fusion: part II. No clinical benefit for asymptomatic, initially degenerated adjacent segments after 6 years follow-up","volume":"19","author":"Putzier","year":"2010"},{"key":"b19-focus15413","series-title":"Spine (Phila Pa 1976)","first-page":"E636","article-title":"Minimum four-year follow-up of spinal stenosis with degenerative spondylolisthesis treated with decompression and dynamic stabilization","volume":"33","author":"Schaeren","year":"2008"},{"key":"b20-focus15413","series-title":"J Spinal Disord Tech","first-page":"418","article-title":"Dynamic stabilization of the lumbar spine and its effects on adjacent segments: an in vitro experiment","volume":"16","author":"Schmoelz","year":"2003"},{"key":"b21-focus15413","series-title":"Spine (Phila Pa 1976)","first-page":"442","article-title":"Dynamic stabilization in addition to decompression for lumbar spinal stenosis with degenerative spondylolisthesis","volume":"31","author":"Schnake","year":"2006"},{"key":"b22-focus15413","series-title":"Eur Spine J","first-page":"2171","article-title":"Dynamic stabilization adjacent to single-level fusion: part I. Biomechanical effects on lumbar spinal motion","volume":"19","author":"Strube","year":"2010"},{"key":"b23-focus15413","series-title":"Turk Neurosurg","first-page":"579","article-title":"Can posterior dynamic stabilization reduce the risk of adjacent segment deterioration?","volume":"23","author":"Zhou","year":"2013"}],"container-title":["Neurosurgical Focus"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/40\/1\/article-pE5.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/40\/1\/article-pE5.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/40\/1\/article-pE5.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T08:31:54Z","timestamp":1779525114000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/40\/1\/article-pE5.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,1]]},"references-count":46,"journal-issue":{"issue":"1"},"URL":"https:\/\/doi.org\/10.3171\/2015.10.focus15413","relation":{},"ISSN":["1092-0684"],"issn-type":[{"value":"1092-0684","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,1]]}}}