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Dynamic Stabilisation


Over the last ten years, new techniques have been developed to stabilise spinal segments in a non-rigid “dynamic” fashion. These techniques include artificial disc replacement surgery (see “artificial disc replacement”), interspinous processes spacers (x-stop, Wallis, etc) and dynamic stabilisation using pedicle screw fixation connected by non-rigid means (polyethilene cables and polycarbonate sleeve spacers) (Dynesys).

In Dr Osti’s Practice, the Dynesys technique (Fig.1) has been used in selected cases, when moderate instability is present in older individuals where more rigid fixation may carry a higher risk of either implant and/or bone healing failure.

Patients suitable for this technique are generally over 60, with grade 1 (moderate) spondylolisthesis (anterior slip of one or more vertebrae) and where back pain is a significant symptom in association with leg pain due to nerve pressure. The operation is carried out as for other similar procedures with a vertical posterior skin incision over the lumbar spine and the pedicle screws are inserted into the selected vertebrae in a normal “fashion” (see “pedicle screw fixation”).

 




The difference with the conventional technique is that the screw heads, rather than being connected with a pair of rigid or semi-rigid steel rods are linked by two polyethilene cords and separated from each other by polycarbonate (plastic) sleeves, cut at selected lengths to achieve adequate tension and to stabilise dynamically the operated segments (Fig.2). Generally no bone graft is used.


In a published large series of cases operated with this technique, the two year follow-up results suggested lower complications, both general and/or related to instrumentation, when compared to similar series with conventional stabilisation techniques with rigid steel rods and bone graft. The expected but yet unproven advantages of dynamic stabilisation include reduced stress on the stabilised and adjacent levels, reduced morbidity and post-operative pain due to absence of bone graft and potential partial preservation of movement at the operated segments.

The post-operative regimen includes early mobilisation within 24 hours of surgery and discharge from Hospital within three days. Patients are advised to avoid any activities associated with repetitive strain to the lower back for six weeks. Plain lumbar x-rays are taken after six weeks, six months and yearly afterwards.

 




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