Comparative study between the efficacy of Isobar TTL and Isobar EVO systems for lumbar degenerative diseases and their effects on adjacent segment degeneration

Xiaozhe Zhang; Jianbin Guan; Kesong Shi; Tongzheng Wang; Yaqi Zhang; Wei Li; Tao Zhang; Xing Yu; Ziyi Zhao

doi:10.2298/VSP250418018Z

Xiaozhe Zhang Beijing Changping Hospital of Integrated Chinese and Western Medicine, Department of Orthopedics, Beijing, China
Jianbin Guan Beijing University of Chinese Medicine, Dongzhimen Hospital, Department of Orthopedics, Beijing, China
Kesong Shi Beijing Changping Hospital of Integrated Chinese and Western Medicine, Department of Orthopedics, Beijing, China
Tongzheng Wang Puyang TCM Hospital, Department of Orthopedics, Henan, China
Yaqi Zhang Beijing University of Chinese Medicine, Dongzhimen Hospital, Department of Orthopedics, Beijing, China
Wei Li Beijing Hospital of Traditional Chinese Medicine, Department of Orthopedics, Beijing, China
Tao Zhang Beijing Changping Hospital of Integrated Chinese and Western Medicine, Department of Orthopedics, Beijing, China
Xing Yu Beijing University of Chinese Medicine, Dongzhimen Hospital, Department of Orthopedics, Beijing, China
Ziyi Zhao Beijing Hospital of Traditional Chinese Medicine, Department of Orthopedics, Beijing, China

DOI: https://doi.org/10.2298/VSP250418018Z

Keywords: neurosurgical procedures;, spinal diseases;, spinal fusion.

Abstract

Background/Aim. Lumbar degenerative diseases (LDD) are diseases that occur due to normal aging and degeneration of the lumbar spine. In addition to conservative therapies, surgical procedures become necessary to achieve satisfactory clinical outcomes. The aim of this study was to evaluate the effectiveness of the Isobar TTL and Isobar Evolution (EVO) systems of dynamic internal stabilization in the treatment of LDD and their effects on adjacent segment degeneration. Methods. This research involved 78 LDD patients treated with Isobar TTL or Isobar EVO dynamic internal stabilization devices. Patients were divided into two groups: TTL (n = 40) and EVO (n = 38). Visual Analog Scale (VAS) pain ratings, Oswestry Disability Index (ODI) scores, and modified MacNab criteria effectiveness evaluations were performed preoperatively, 1 and 3 months postoperatively, and at the final follow-up. Range of motion (ROM) and intervertebral space ratio (IVSR) were measured preoperatively and after the final follow-up. Results. In almost two years, 37 TTL and 33 EVO patients completed every examination. After surgery, VAS and ODI ratings in both groups improved significantly compared to preoperative levels (p < 0.05). The surgical effectiveness of the TTL and EVO groups was rated as excellent or good using the modified MacNab criteria (91.89% and 93.94%, respectively). Preoperative ROM and IVSR values did not differ between the groups (p > 0.05). At the final follow-up, the EVO group had a significantly higher ROM than the TTL group (4.46 ± 1.19° vs. 2.58 ± 0.71°; p < 0.05) and the ROM of adjacent segments in the TTL group was significantly higher than that of the EVO group (6.74 ± 1.55° vs. 5.83 ± 1.32°; p < 0.05). The IVSR of the operated and surrounding segments did not change substantially from preoperative to final follow-up (p > 0.05). Moreover, there was no significant difference in IVSRs between the two groups for the operated and neighboring segments at the final follow-up (p > 0.05). Conclusion. Isobar TTL and Isobar EVO dynamic stabilization systems demonstrated good clinical outcomes. The ability of Isobar EVO to inhibit neighboring segment motion may prevent degeneration.

Author Biography

Kesong Shi, Beijing Changping Hospital of Integrated Chinese and Western Medicine, Department of Orthopedics, Beijing, China

References

Ajiboye LO, Alimi M, Gbadegesin SA, Oboirien M. Treat-ment outcome of quality of life and clinical symptoms in pa-tients with symptomatic lumbar degenerative disc diseases: which treatment modality is superior? Int Orthop 2019; 43(4): 875–81. DOI: 10.1007/s00264-018-4248-5.

Chiloiro G, Meldolesi E, Giraffa M, Capocchiano ND, Barbaro B, Coco C, et al. Could the conservative approach be considered safe in the treatment of locally advanced rectal cancer in case of a clinical near-complete or complete response? A retrospec-tive analysis. Clin Transl Radiat Oncol 2021; 28: 1–9. DOI: 10.1016/j.ctro.2021.02.009.

Ji ZS, Yang H, Yang YH, Li SJ, Luo JX, Zhang GW, et al. Analysis of clinical effect and radiographic outcomes of Isobar TTL system for two-segment lumbar degenerative disease: a retrospective study. BMC Surg 2020; 20(1): 15. DOI: 10.1186/s12893-020-0680-8.

Li Z, Li F, Yu S, Ma H, Chen Z, Zhang H, et al. Two-year fol-low-up results of the Isobar TTL Semi-Rigid Rod System for the treatment of lumbar degenerative disease. J Clin Neurosci 2013; 20(3): 394–9. DOI: 10.1016/j.jocn.2012.02.043.

Bredow J, Löhrer L, Oppermann J, Scheyerer MJ, Sobottke R, Eysel P, et al. Pathoanatomic Risk Factors for Instability and Adja-cent Segment Disease in Lumbar Spine: How to Use Topping off? Biomed Res Int 2017; 2017: 2964529. DOI: 10.1155/2017/2964529.

Guan J, Liu T, Feng N, Jiang G, Li W, Yang K, et al. Compari-son between single-segment Isobar EVO dynamic stabilization and Isobar TTL dynamic stabilization in the treatment of lumbar degenerative diseases: a single center retrospective study over 4 years. BMC Musculoskelet Disord 2022; 23(1): 998. DOI: 10.1186/s12891-022-05913-6.

Qian J, Bao Z, Li X, Zou J, Yang H. Short-Term Therapeutic Efficacy of the Isobar TTL Dynamic Internal Fixation System for the Treatment of Lumbar Degenerative Disc Diseases. Pain Physician 2016; 19(6): 853–61.

Sasani M, Aydin AL, Oktenoglu T, Cosar M, Ataker Y, Kaner T, et al. The combined use of a posterior dynamic transpedicular stabilization system and a prosthetic disc nucleus device in treating lumbar degenerative disc disease with disc herniations. SAS J 2008; 2(3): 130–6. DOI: 10.1016/SASJ-2008-0008-NT.

Umehara S, Zindrick MR, Patwardhan AG, Havey RM, Vrbos LA, Knight GW, et al. The biomechanical effect of postoper-ative hypolordosis in instrumented lumbar fusion on instru-mented and adjacent spinal segments. Spine (Phila Pa 1976) 2015; 25(13): 1617–24. DOI: 10.1097/00007632-200007010-00004.

Hilibrand AS, Carlson GD, Palumbo MA, Jones PK, Bohlman HH. Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg Am 1999; 81(4): 519–28. DOI: 10.2106/00004623-199904000-00009.

Veeravagu A, Cole T, Jiang B, Ratliff JK. Revision rates and complication incidence in single- and multilevel anterior cer-vical discectomy and fusion procedures: an administrative da-tabase study. Spine J 2014; 14(7): 1125–31. DOI: 10.1016/j.spinee.2013.07.474.

Chou PH, Lin HH, An HS, Liu KY, Su WR, Lin CL. 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. Bio-med Res Int 2017; 2017: 4385620. DOI: 10.1155/2017/4385620.

Kundu B, Eli I, Dailey A, Shah LM, Mazur MD. Preoperative Magnetic Resonance Imaging Abnormalities Predict Sympto-matic Adjacent Segment Degeneration After Anterior Cervical Discectomy and Fusion. Cureus 2021; 13(8): e17282. DOI: 10.7759/cureus.17282.

Liu ZZ, Zhang ZM, Jin DD. Factors affecting adjacent segment degeneration after rigid lumbar internal fixation. Nan Fang Yi Ke Da Xue Xue Bao 2010; 30(5): 1134–7. (Chinese)

Nakashima H, Kawakami N, Tsuji T, Ohara T, Suzuki Y, Saito T, et al. Adjacent segment disease after posterior lumbar inter-body fusion: based on cases with a minimum of 10 years of follow-up. Spine (Phila Pa 1976) 2015; 40(14): E831–41. DOI: 10.1097/BRS.0000000000000917.

Kaner T, Ozer AF. Dynamic stabilization for challenging lum-bar degenerative diseases of the spine: a review of the litera-ture. Adv Orthop 2013; 2013: 753470. DOI: 10.1155/2013/753470.

Wang H, Lv B. Comparison of clinical and radiographic results between posterior pedicle-based dynamic stabilization and posterior lumbar intervertebral fusion for lumbar degenerative disease: a 2-year retrospective study. World Neurosurg 2018; 114: e403–11. DOI: 10.1016/j.wneu.2018.02.192.

Liu C, Kamara A, Yan Y. Investigation into the biomechanics of lumbar spine micro-dynamic pedicle screw. BMC Musculo-skelet Disord 2018; 19(1): 231. DOI: 10.1186/s12891-018-2132-5.

Barrey C, Perrin G, Champain S. Pedicle-Screw-Based Dynamic Systems and Degenerative Lumbar Diseases: Biomechanical and Clinical Experiences of Dynamic Fusion with Isobar TTL. IVSRN Orthop 2013; 2013: 183702. DOI: 10.1155/2013/183702.

Sengupta DK. Dynamic stabilization devices in the treatment of low back pain. Orthop Clin North Am 2004; 35(1): 43–56. DOI: 10.1016/S0030-5898(03)00087-7.

Oikonomidis S, Ashqar G, Kaulhausen T, Herren C, Siewe J, Sobottke R. Clinical experiences with a PEEK-based dynamic instrumentation device in lumbar spinal surgery: 2 years and no more. J Orthop Surg Res 2018; 13(1): 196. DOI: 10.1186/s13018-018-0905-z.

Tu J, Hua W, Li W, Liu W, Luo R, Li S, et al. Short-term ef-fects of minimally invasive dynamic neutralization system for the treatment of lumbar spinal stenosis: An observational study. Medicine (Baltimore) 2018; 97(22): e10854. DOI: 10.1097/MD.0000000000010854.

Yeh MY, Kuo CH, Wu JC, Huang WC, Tu TH, Fay LY, et al. Changes of Facet Joints After Dynamic Stabilization: Contin-uous Degeneration or Slow Fusion? World Neurosurg 2018; 113: e45–50. DOI: 10.1016/j.wneu.2018.01.148.

Peng BG, Gao CH. Is Dynesys dynamic stabilization system su-perior to posterior lumbar fusion in the treatment of lumbar degenerative diseases? World J Clin Cases 2020; 8(22): 5496–500. DOI: 10.12998/wjcc.v8.i22.5496.

Li J, Li Q, Deng Z, Wang L, Wang L, Song Y. Long-term Out-come of Isobar TTL System for the Treatment of Lumbar De-generative Disc Diseases. Orthop Surg 2024; 16(4): 912–20. DOI: 10.1111/os.14025.

Guan J, Liu T, Yu X, Li W, Feng N, Jiang G, et al. Biomechan-ical and clinical research of Isobar semi-rigid stabilization de-vices for lumbar degenerative diseases: a systematic review. Biomed Eng Online 2023; 22(1): 95. DOI: 10.1186/s12938-023-01156-1.

Zeng J, Liu H, Wang B, Gong Q, Yang Y, Chen H, et al. Clinical outcome of ISOBAR TTL dynamic stabilization with pars bone grafting for treatment of lumbar spondylolysis. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2017; 31(1): 62–5. (Chinese) DOI: 10.7507/1002-1892.201609104.

Liu YL, Yang H, Zhang M, Ruan TC, Li PF, Xiong YJ, et al. Short-term effect of Isobar dynamic stabilization system fixa-tion combined with lumbar discectomy in patients with lum-bar disc herniation. Zhonghua Yi Xue Za Zhi 2019; 99(3): 188–92. (Chinese) DOI: 10.3760/cma.j.issn.0376-2491.2019.03.007.

Gao J, Zhao W, Zhang X, Nong L, Zhou D, Lv Z, et al. MRI analysis of the ISOBAR TTL internal fixation system for the dynamic fixation of intervertebral discs: a comparison with rigid internal fixation. J Orthop Surg Res 2014; 9: 43. DOI: 10.1186/1749-799X-9-43.

Zhou Q, Shi R, Kopjar B, Wang H, Chen D, Li H, et al. Adjacent Intervertebral Disc Changes in Patients with Isobar Semirigid Dynamic Stabilization System. Global Spine J 2017; 4 (1_suppl): s-0034-1376699. DOI:10.1055/s-0034-1376699.

Paholpak P, Wang Z, Sakakibara T, Kasai Y. An increase in height of spinous process is associated with decreased heights of intervertebral disc and vertebral body in the degenerative process of lumbar spine. Eur Spine J 2013; 22(9): 2030–4. DOI: 10.1007/s00586-013-2764-y.

Mallio CA, Vadalà G, Russo F, Bernetti C, Ambrosio L, Zobel BB, et al. Novel Magnetic Resonance Imaging Tools for the Diagnosis of Degenerative Disc Disease: A Narrative Review Diagnostics (Basel) 2022; 12(2): 420. DOI: 10.3390/diagnostics12020420.

Sun Y, Guan J, Chen H, Sun X, Yang K, Fang Q. The value of fixed segment mobility in posterior dynamic stabilization: a single-center retrospective study. BMC Musculoskelet Disord 2025; 26(1): 96. DOI: 10.1186/s12891-025-08333-4.