Evaluation of clinical and radiological outcomes of Rigid, Dynamic, and Hybrid stabilization systems in degenerative Lumbar spine surgery

Abstract

Retrospective comparative cohort study. This study aimed to compare the clinical and radiological outcomes of rigid, dynamic, and hybrid stabilization systems in the surgical management of degenerative lumbar spine disease, with a focus on adjacent segment disease (ASD), fusion-related complications, and postoperative recovery. Rigid fusion techniques provide immediate stability but may increase mechanical stress at adjacent segments, leading to ASD. Dynamic and hybrid constructs aim to preserve more physiological motion, potentially reducing fusion-related complications. Methods: A retrospective analysis was conducted on 86 patients who underwent posterior lumbar stabilization between January 2017 and December 2021. Patients were categorized into four groups based on the surgical technique: Rigid (titanium rod), Dynamic (PEEK rod), Rigid + TLIF (Transforaminal Lumbar Interbody Fusion), and Hybrid (Dynamic + TLIF). Clinical evaluation included the Visual Analog Scale (VAS) for back and leg pain. Radiological assessments comprised segmental and total range of motion (ROM), disc and foraminal height, fusion success, pseudoarthrosis, and the presence of ASD. Results: All surgical approaches resulted in significant postoperative improvement in back and leg pain (p < 0.001). The incidence of ASD was highest in the Rigid + TLIF group (45.5%, p < 0.001) and lowest in the Dynamic (4.8%) and Hybrid (4.2%) groups. Pseudoarthrosis was most frequently observed in the Rigid group (26.3%). The Hybrid group demonstrated favorable outcomes, with a high anterior fusion rate (91.7%) and low rates of ASD and pseudoarthrosis. Conclusions: All stabilization techniques were associated with significant postoperative clinical improvement. In this retrospective cohort, dynamic and hybrid constructs showed lower observed rates of early symptomatic ASD than the Rigid + TLIF construct, while TLIF-treated groups showed higher anterior fusion rates. Because treatment allocation was nonrandomized and adjustment for all potential confounders was not possible, these findings demonstrate associations rather than causal treatment effects. Larger prospective studies with longer follow-up are required to determine whether the stabilization strategy independently influences ASD, fusion, or pseudoarthrosis.