Interspinous spacers were developed to treat local deformities such as degenerative spondylolisthesis. To treat patients with chronic instability, posterior pedicle fixation and rod-based dynamic stabilization systems were developed as alternatives to fusion surgeries. Dynamic stabilization is the future of spinal surgery, and in the near future, we will be able to see the development of new devices and surgical techniques to stabilize the spine. It is important to follow the development of these technologies and to gain experience using them. In this paper, we review the literature and discuss the dynamic systems, both past and present, used in the market to treat lumbar degeneration. 1. Introduction Lumbar spine degeneration was first described by Kirkaldy-Willis and Farfan in 1982, using a 3 stage concept: (1) temporal dysfunction, (2) unstable stage, and (3) stabilization [1]. Stage 1 patients may respond to conservative treatments, but stage 2 and stage 3 patients require surgery for stabilization, decompression, and to correct deformities. Although disc degeneration is one reason for chronic lower back pain, the primary reason for back pain is the instability of the lumbar spine [2]. However, lumbar instability is not clearly defined. Kirkaldy-Willis and Farfan defined instability as the clinical status of patients with back problems who, with the least provocation, transition from being mildly symptomatic to experiencing a severe episode [1]. According to Panjabi [3] instability results from the inability to maintain control of the lumbar neutral zone, where spine motion occurs with minimal internal resistance and within normal physiological limits. In this study, instability is defined as the source of pain and abnormal motion. Stokes at al. [4] and Weiler et al. [5] also related abnormal motion to chronic back pain. However, as a definition of instability, abnormal motion does not cause back pain in all cases, such as when abnormal movement is observed radiologically in degenerated discs associated with spondylolisthesis, and pain is not continuous [6]. Therefore, the definition of instability has been updated to include abnormal movements at the joint surface and altered load transmission [2]. Lumbar spinal fusion is a common surgical treatment used in disc degeneration, which is related to chronic lower back pain and other spinal disorders, such as disc herniation, spondylolisthesis, facet arthropathy, and spinal stenosis [7]. Spinal fusion was first described by Albee for the treatment of Pott disease [8] and by Hibbs who performed spinal
References
[1]
W. H. Kirkaldy-Willis and H. F. Farfan, “Instability of the lumbar spine,” Clinical Orthopaedics and Related Research, no. 165, pp. 110–123, 1982.
[2]
S. Lau and K. S. Lam, “Lumbar stabilisation techniques,” Current Orthopaedics, vol. 21, no. 1, pp. 25–39, 2007.
[3]
M. M. Panjabi, “The stabilizing system of the spine. Part II. Neutral zone and instability hypothesis,” Journal of Spinal Disorders, vol. 5, no. 4, pp. 390–397, 1992.
[4]
I. A. Stokes and J. W. Frymoyer, “Segmental motion and instability,” Spine, vol. 12, no. 7, pp. 688–691, 1987.
[5]
P. J. Weiler, G. J. King, and S. D. Gertzbein, “Analysis of sagittal plane instability of the lumbar spine in vivo,” Spine, vol. 15, no. 12, pp. 1300–1306, 1990.
[6]
R. C. Mulholland and D. K. Sengupta, “Rationale, principles and experimental evaluation of the concept of soft stabilization,” European Spine Journal, vol. 11, supplement 2, pp. S198–S205, 2002.
[7]
Q. H. Zhang and E. C. Teo, “Finite element application in implant research for treatment of lumbar degenerative disc disease,” Medical Engineering and Physics, vol. 30, no. 10, pp. 1246–1256, 2008.
[8]
F. H. Albee, “Transplantation of a portion of the tibia into the spine for Pott's disease,” Journal of the American Medical Association, vol. 57, p. 11, article 885, 1911.
[9]
R. A. Hibbs, “An operation for progressive spinal deformities,” New York Medical Journal, vol. 93, pp. 1013–1016, 1911.
[10]
B. C. Cheng, J. Gordon, J. Cheng, and W. C. Welch, “Immediate biomechanical effects of lumbar posterior dynamic stabilization above a circumferential fusion,” Spine, vol. 32, no. 23, pp. 2551–2557, 2007.
[11]
A. Kumar, J. Beastall, J. Hughes et al., “Disc changes in the bridged and adjacent segments after Dynesys dynamic stabilization system after two years,” Spine, vol. 33, no. 26, pp. 2909–2914, 2008.
[12]
A. Gardner and K. C. Pande, “Graf ligamentoplasty: a 7-year follow-up,” European Spine Journal, vol. 11, supplement 2, pp. S157–S163, 2002.
[13]
C. K. Lee, “Accelerated degeneration of the segment adjacent to a lumbar fusion,” Spine, vol. 13, no. 3, pp. 375–377, 1988.
[14]
A. S. Hilibrand and M. Robbins, “Adjacent segment degeneration and adjacent segment disease: the consequences of spinal fusion?” Spine Journal, vol. 4, supplement 6, pp. S190–S194, 2004.
[15]
J. S. Harrop, J. A. Youssef, M. Maltenfort et al., “Lumbar adjacent segment degeneration and disease after arthrodesis and total disc arthroplasty,” Spine, vol. 33, no. 15, pp. 1701–1707, 2008.
[16]
P. Park, H. J. Garton, V. C. Gala, J. T. Hoff, and J. E. McGillicuddy, “Adjacent segment disease after lumbar or lumbosacral fusion: review of the literature,” Spine, vol. 29, no. 17, pp. 1938–1944, 2004.
[17]
C. M. Bono, M. Kadaba, and A. R. Vaccaro, “Posterior pedicle fixation-based dynamic stabilization devices for the treatment of degenerative diseases of the lumbar spine,” Journal of Spinal Disorders and Techniques, vol. 22, no. 5, pp. 376–383, 2009.
[18]
H. Y. Zhang, J. Y. Park, and B. Y. Cho, “The BioFlex system as a dynamic stabilization device: does it preserve lumbar motion?” Journal of Korean Neurosurgical Society, vol. 46, no. 5, pp. 431–436, 2009.
[19]
D. K. Sengupta, “Dynamic stabilization devices in the treatment of low back pain,” Neurology India, vol. 53, no. 4, pp. 466–474, 2005.
[20]
J. J. Song, C. Y. Barrey, R. K. Ponnappan, J. T. Bessey, A. L. Shimer, and A. R. Vaccaro, “Pedicle screw-based dynamic stabilization of the lumbar spine,” Pan Arab Journal of Neurosurgery, vol. 14, no. 1, pp. 1–141, 2010.
[21]
P. Khoueir, K. A. Kim, and M. Y. Wang, “Classification of posterior dynamic stabilization devices,” Neurosurgical Focus, vol. 22, no. 1, article E3, 2007.
[22]
T. Kaner, M. Sasani, T. Oktenoglu, and A. F. Ozer, “Dynamic stabilization of the spine: a new classification system,” Turkish Neurosurgery, vol. 20, no. 2, pp. 205–215, 2010.
[23]
H. Graf, “Evaluation of the therapeutic effect of the graf stabilisation system,” in Proceedings of the 2nd Annual Meeting of the European Spine Society, Rome, Italy, 1991.
[24]
M. P. Grevitt, A. D. H. Gardner, J. Spilsbury et al., “The Graf stabilisation system: early results in 50 patients,” European Spine Journal, vol. 4, no. 3, pp. 169–175, 1995.
[25]
T. M. Markwalder and M. Wenger, “Dynamic stabilization of lumbar motion segments by use of Graf's ligaments: results with an average follow-up of 7.4 years in 39 highly selected, consecutive patients,” Acta Neurochirurgica, vol. 145, no. 3, pp. 209–214, 2003.
[26]
S. V. Hadlow, A. B. Fagan, T. M. Hillier, and R. D. Fraser, “The graft ligamentoplasty procedure: comparison with posterolateral fusion in the management of low back pain,” Spine, vol. 23, no. 10, pp. 1172–1179, 1998.
[27]
T. M. Stoll, G. Dubois, and O. Schwarzenbach, “The dynamic neutralization system for the spine: a multi-center study of a novel non-fusion system,” European Spine Journal, vol. 11, supplement 2, pp. S170–S178, 2002.
[28]
R. B. Delamarter, J. Maxwell, R. Davis, J. Sherman, and W. Welch, “Nonfusion application of the Dynesys system in the lumbar spine: early results from IDE multicenter trial,” Spine Journal, vol. 6, supplement 1, article S77, no. 5, 2006.
[29]
K. J. Schnake, S. Schaeren, and B. Jeanneret, “Dynamic stabilization in addition to decompression for lumbar spinal stenosis with degenerative spondylolisthesis,” Spine, vol. 31, no. 4, pp. 442–449, 2006.
[30]
B. Cakir, B. Ulmar, H. Koepp, K. Huch, W. Puhl, and M. Richter, “Posterior dynamic stabiliziation as on alternative for instrumented fusion in the treatment of degenerative lumbar instability with spinal stenosis,” Zeitschrift fur Orthopadie und Ihre Grenzgebiete, vol. 141, no. 4, pp. 418–424, 2003.
[31]
C. Feloukatzis, G. Barlas, S. Pichas, and L. Drosos, “The dynamic neutralization system (Dynesys) in the treatment of degenerative lumbar spine disease,” in Proceedings of the 3rd Interdisciplinary Congress on Spine Care, Rio De Janeiro, Brazil, July 2005.
[32]
D. Grob, A. Benini, A. Junge, and A. F. Mannion, “Clinical experience with the dynesys semirigid fixation system for the lumbar spine: surgical and patient-oriented outcome in 50 cases after an average of 2 years,” Spine, vol. 30, no. 3, pp. 324–331, 2005.
[33]
M. Bothmann, E. Kast, G. J. Boldt, and J. Oberle, “Dynesys fixation for lumbar spine degeneration,” Neurosurgical Review, vol. 31, no. 2, pp. 189–196, 2008.
[34]
J. Cienciala, R. Chaloupka, M. Repko, and M. Krbec, “Dynamic neutralization using the dynesys system for treatment of degenerative disc disease of the lumbar spine,” Acta Chirurgiae Orthopaedicae et Traumatologiae Cechoslovaca, vol. 77, no. 3, pp. 203–208, 2010.
[35]
A. Reyes-Sánchez, B. Zárate-Kalfópulos, I. Ramírez-Mora, L. M. Rosales-Olivarez, A. Alpizar-Aguirre, and G. Sánchez-Bringas, “Posterior dynamic stabilization of the lumbar spine with the Accuflex rod system as a stand-alone device: experience in 20 patients with 2-year follow-up,” European Spine Journal, vol. 19, no. 12, pp. 2164–2170, 2010.
[36]
G. Perrin and A. Cristini, “Prevention of adjacent level degeneration above a fused vertebral segment: long term effect, a fter a mean follow up of 8, 27 years, of the semi-rigid intervertebral fixation as a protective technique for pathological adjacent disc,” in Proceedings of the International Meeting for Advanced Spine Technologies, December 2003.
[37]
K. O. Abode-Iyamah, E. M. Cox, R. Kumar, and P. W. Hitchon, “PEEK rods decrease intradiscal pressure in levels adjacent to spinal instrumentation,” in Proceedings of the Congress of Neurological Surgeons Annual Meeting (CNS '11), Washington, DC, USA, 2011.
[38]
Y. S. Kim, H. Y. Zhang, B. J. Moon et al., “Nitinol spring rod dynamic stabilization system and Nitinol memory loops in surgical treatment for lumbar disc disorders: short-term follow up,” Neurosurgical Focus, vol. 22, no. 1, article E10, 2007.
[39]
D. K. Sengupta and R. C. Mulholland, “Fulcrum assisted soft stabilization system: a new concept in the surgical treatment of degenerative low back pain,” Spine, vol. 30, no. 9, pp. 1019–1029, 2005.
[40]
H. Bozkus, M. Seno？lu, S. Baek et al., “Dynamic lumbar pedicle screw-rod stabilization: in vitro biomechanical comparison with standard rigid pedicle screw-rod stabilization—laboratory investigation,” Journal of Neurosurgery Spine, vol. 12, no. 2, pp. 183–189, 2010.
[41]
W. Schmoelz, J. F. Huber, T. Nydegger, Dipl-Ing, L. Claes, and H. J. Wilke, “Dynamic stabilization of the lumbar spine and its effects on adjacent segments: an in vitro experiment,” Journal of Spinal Disorders and Techniques, vol. 16, no. 4, pp. 418–423, 2003.
[42]
T. Oktenoglu, A. F. Ozer, M. Sasani et al., “Posterior dynamic stabilization in the treatment of lumbar degenerative disc disease: 2-year follow-up,” Minimally Invasive Neurosurgery, vol. 53, no. 3, pp. 112–116, 2010.
[43]
T. Kaner, S. Dalbayrak, T. Oktenoglu, M. Sasani, A. L. Aydin, and F. O. Ozer, “Comparison of posterior dynamic and posterior rigid transpedicular stabilization with fusion to treat degenerative spondylolisthesis,” Orthopedics, vol. 33, no. 5, article 309, 2010.
[44]
A. F. Ozer, N. R. Crawford, M. Sasani et al., “Dynamic lumbar pedicle screw-rod stabilization: two-year follow-up and comparison with fusion,” The Open Orthopaedics Journal, vol. 4, pp. 137–141, 2010.
[45]
T. Kaner, M. Sasani, T. Oktenoglu, A. L. Aydin, and A. F. Ozer, “Clinical outcomes of degenerative lumbar spinal stenosis treated with lumbar decompression and the Cosmic “semi-rigid” posterior system,” SAS Journal, vol. 4, no. 4, pp. 99–106, 2010.
[46]
T. Kaner, M. Sasani, T. Oktenoglu, A. L. Aydin, and A. F. Ozer, “Minimum two-year follow-up of cases with recurrent disc herniation treated with microdiscectomy and posterior dynamic transpedicular stabilisation,” The Open Orthopaedics Journal, vol. 4, pp. 120–125, 2010.
[47]
A. Maleci, R. D. Sambale, M. Schiavone, F. Lamp, A. F. Ozer, and A. von Strempel, “Nonfusion stabilization of the degenerative lumbar spine,” Journal of Neurosurgery Spine, vol. 15, no. 2, pp. 151–158, 2011.
[48]
A. von Strempel, D. Moosman, C. Stoss, and A. Martin, “Stabilization of the degenerated lumbar spine in the non fusion technique with Cosmic posterior dynamic system,” World Spine Journal, vol. 1, no. 1, pp. 40–47, 2006.
[49]
M. Stoffel, M. Behr, A. Reinke, C. Stüer, F. Ringel, and B. Meyer, “Pedicle screw-based dynamic stabilization of the thoracolumbar spine with the Cosmic-system: a prospective observation,” Acta Neurochirurgica, vol. 152, no. 5, pp. 835–843, 2010.
[50]
D. Erbulut, “Kinematical and load sharing effect of a novel posterior dynamic stabilization system implanted in lumbar spine,” in Proceedings of the 36th Annual Meeting of the American Society of Biomechanics, Gainesville, Fla, USA, August 2012.
[51]
T. Kaner, M. Sasani, T. Oktenoglu, M. Cosar, and A. F. Ozer, “Utilizing dynamic rods with dynamic screws in the surgical treatment of chronic instability: a prospective clinical study,” Turkish Neurosurgery, vol. 19, no. 4, pp. 319–326, 2009.
[52]
D. K. Sengupta, H. N. Herkowitz, S. Hochschuler, and R. C. Mullholland, “Load sharing characteristics of two novel soft stabilization devices in the lumbar motion segments-a biomechanical study in cadaver spine,” in Proceedings of the Spine Arthroplasty Society Congress, 2003.
[53]
D. Sengupta, R. C. Mulholland, and L. Pimenta, “Prospective clinical study of dynamic stabilization with the DSS system in isolated activity related mechanical low back pain, with outcome at minimum 2-year follow-up,” Spine Journal, vol. 6, no. 5, article 147, 2006.
[54]
H. J. Wilke, H. Schmidt, K. Werner, W. Schm？lz, and J. Drumm, “Biomechanical evaluation of a new total posterior-element replacement system,” Spine, vol. 31, no. 24, pp. 2790–2796, 2006.
[55]
P. McAfee, L. T. Khoo, L. Pimenta et al., “Treatment of lumbar spinal stenosis with a total posterior arthroplasty prosthesis: implant description, surgical technique, and a prospective report on 29 patients,” Neurosurgical Focus, vol. 22, no. 1, article E13, 2007.
[56]
F. M. Phillips, M. N. Tzermiadianos, L. I. Voronov et al., “Effect of the Total Facet Arthroplasty system after complete laminectomy-facetectomy on the biomechanics of implanted and adjacent segments,” Spine Journal, vol. 9, no. 1, pp. 96–102, 2009.
[57]
J. Senegas, J. P. Etchevers, J. M. Vital, D. Baulny, and F. Grenier, “Widening of the lumbar vertebral canal as an alternative to laminectomy in the treatment of lumbar stenosis,” Revue de Chirurgie Orthopedique et Reparatrice de l'Appareil Moteur, vol. 74, no. 1, pp. 15–22, 1988.
[58]
O. J. Verhoof, J. L. Bron, F. H. Wapstra, and B. J. Van Royen, “High failure rate of the interspinous distraction device (X-Stop) for the treatment of lumbar spinal stenosis caused by degenerative spondylolisthesis,” European Spine Journal, vol. 17, no. 2, pp. 188–192, 2008.
[59]
J. F. Zucherman, K. Y. Hsu, C. A. Hartjen et al., “A multicenter, prospective, randomized trial evaluating the X STOP interspinous process decompression system for the treatment of neurogenic intermittent claudication: two-year follow-up results,” Spine, vol. 30, no. 12, pp. 1351–1358, 2005.
