Preserving spinal motion
Fusion is one of the most commonly performed spinal procedures, and the indications for this intervention cover a wide range of spinal problems. However, eliminating motion on one level will lead to an accelerated degeneration of the adjacent level, which is known as “adjacent level disease”; to avoid this complication, surgeons developed methods to preserve motion. In the present paper, Greek orthopedics from the University Hospital of Ioannina give an overview of the indications and applications for spinal motion preservation surgery.
Spinal motion preservation surgical technics include total disc replacement, laminoplasty, interspinous implants and dynamic posterior stabilization systems. While initially very well received, concerns were soon raised about these methods regarding their actual clinical usefulness and outcomes. Another issue is patient selection, explain the authors: The main indication for total disc replacement is degenerative disc disease, but due to the numerous contraindications for this method, choosing the right candidate can be a challenge in clinical practice.
With respect to the various techniques and their applications the authors report:
Interspinous implants have shown good results in patients with spinal stenosis, but there is a lack of a precise definition regarding the severity of spinal stenosis up to which these implants can be used successfully.
In patients with cervical myelopathy/radiculopathy, laminoplasty has several advantages and fewer complications than fusion and laminectomy.
And: Dynamic posterior stabilization could replace conventional fusion in certain cases. However, this technique has only been shown to be successful in mild to moderate cases.