Stand-Alone Interbody Devices: Static Versus Dynamic
Disc degeneration in the lumbar spine accounts for the vast majority of non-acute spine pathology. Progressive loss of disc height leads to a cascade of biomechanical and morphological changes locally in the functional spinal unit (FSU), which in turn may affect the adjacent segments. Loss of disc height may lead to neural compression, facet joint arthropathy, and progressive instability. Multilevel disc degeneration may affect the global spinal biomechanics and alignment resulting in degenerative kyphoscoliosis.
Treatment of degenerative disc disease (DDD) aims to remove the pain generator (degenerative disc), restore disc height and lordosis, and decompress the neural elements (directly or indirectly). The treatment should take into account the alignment (lordosis) of the FSU and also the global alignment of the spine.
Restoring the disc height is achieved by inserting an interbody device to restore the disc height and lordosis. The interbody device could be static which aims at fusing the spinal segment and stopping the painful movement of the disc and the facets, or dynamic, which maintains full or partial controlled movement of the spinal segment as close as possible to the physiological movement (close to the axis of rotation of the disc). The aim of this chapter is to explore the methods of restoring the disc height with either static or dynamic devices and also by combining the two methods depending on the stage of disc degeneration.
The ideal treatment of DDD is to match the pathology with the technology, taking into account patient needs, expectations, comorbidities, and the surgeon’s skills and training.
KeywordsDegenerative disc Interbody fusion Disc replacement Disc height Static interbody Dynamic interbody
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