Background: This study evaluates the impact of hybrid dynamic stabilization using the Dynesys-Transition-Optima (DTO) system on adjacent segment disease (ASD) in lumbar spinal stenosis patients with spondylolisthesis. Methods: From 2012 to 2020, 115 patients underwent DTO stabilization at a single center by a single neurosurgeon. After exclusions for lack of specific stabilization and incomplete data, 31 patients were analyzed. Follow-up was conducted at 6, 12, and 24 months postoperatively, assessing disc height, listhesis distance, and angular motion changes at L2–L3, L3–L4, and L5–S1. Results: L3–L4 segment (the index level), demonstrated a delayed increase in listhesis distance, contrasting with earlier changes in other segments. At two years, L3–L4 exhibited less increase in listhesis distance and less disc height reduction compared to L2–L3 and L5–S1. Notably, the L3–L4 segment showed a significant reduction in angular motion change over two years. Conclusions: In conclusion, while ASD was not significantly prevented, the study indicates minor and delayed degeneration at the index level. The L3–L4 segment experienced reduced angular change in motion, suggesting a potential benefit of DTO in stabilizing this specific segment.
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