Spinal motion preservation surgery: indications and applications
- 507 Downloads
Fusion is one of the most commonly performed spinal procedures, indicated for a wide range of spinal problems. Elimination of motion though results in accelerated degeneration of the adjacent level, known as adjacent level disease. Motion preservation surgical methods were developed in order to overcome this complication. These methods include total disc replacement, laminoplasty, interspinous implants and dynamic posterior stabilization systems. The initial enthusiasm about these methods was followed by certain concerns about their clinical usefulness and their results. The main indications for total disc replacement are degenerative disc disease, but the numerous contraindications for this method make it difficult to find the right candidate. Application of interspinous implants has shown good results in patients with spinal stenosis, but a more precise definition is needed regarding the severity of spinal stenosis up to which these implants can be used. Laminoplasty has several advantages and less complications compared to fusion and laminectomy in patients with cervical myelopathy/radiculopathy. Dynamic posterior stabilization could replace conventional fusion in certain cases, but also in this case the results are successful only in mild to moderate cases.
KeywordsTotal disc replacement Laminoplasty Interspinous implants Dynamic posterior stabilization
Compliance with ethical standards
Conflict of interest
Ioannis D. Gelalis, Dimitrios V. Papadopoulos, Dionysios K. Giannoulis, Andreas G. Tsantes, Anastasios V. Korompilias declare that they have no conflict of interest.
- 1.Zweig T, Aghayev E, Melloh M, Dietrich D, Röder C (2011) Influence of preoperative leg pain and radiculopathy on outcomes in mono-segmental lumbar total disc replacement: results from a nationwide registry. Eur Spine J 21(S6):729–736. doi: 10.1007/s00586-011-1863-x CrossRefPubMedCentralGoogle Scholar
- 10.Holt R, Majd M, Isaza J et al (2007) Complications of lumbar artificial disc replacement compared to fusion: results from the prospective, randomized, multicenter US Food and Drug Administration Investigational Device Exemption Study of the Charité artificial disc. SAS J 1(1):20–27. doi: 10.1016/s1935-9810(07)70043-9 CrossRefPubMedPubMedCentralGoogle Scholar
- 12.Regan J, McAfee P, Blumenthal S et al (2006) Evaluation of surgical volume and the early experience with lumbar total disc replacement as part of the investigational device exemption study of the Charite artificial disc. Spine 31(19):2270–2276. doi: 10.1097/01.brs.0000234726.55383.0c CrossRefPubMedGoogle Scholar
- 24.Yu S, Yen C, Wu C, Kao F, Kao Y, Tu Y (2012) Radiographic and clinical results of posterior dynamic stabilization for the treatment of multisegment degenerative disc disease with a minimum follow-up of 3 years. Arch Orthop Trauma Surg 132(5):583–589. doi: 10.1007/s00402-012-1460-4 CrossRefPubMedGoogle Scholar
- 42.Richter A, Schütz C, Hauck M, Halm H (2009) Does an interspinous device (Coflex™) improve the outcome of decompressive surgery in lumbar spinal stenosis? One-year follow up of a prospective case control study of 60 patients. Eur Spine J 19(2):283–289. doi: 10.1007/s00586-009-1229-9 CrossRefPubMedPubMedCentralGoogle Scholar
- 46.Floman Y, Millgram M, Smorgick Y, Rand N, Ashkenazi E (2007) Failure of the Wallis interspinous implant to lower the incidence of recurrent lumbar disc herniations in patients undergoing primary disc excision. J Spinal Disord Tech 20(5):337–341. doi: 10.1097/bsd.0b013e318030a81d CrossRefPubMedGoogle Scholar
- 48.Chiu JC (2006) Interspinous process decompression (IPD) system (X-STOP) for the treatment of lumbar spinal stenosis. Surg Tech Int 15:265–275Google Scholar
- 51.Sah S, Wang L, Dahal M, Acharya P, Dwivedi R (2012) Surgical management of cervical spondylotic myelopathy. J Nep Med Assoc 52(188):172–177Google Scholar