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
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