Non-Fusion Stabilization of the Spine
in Degenerative Lumbar Compression and Stenosis
November/December 2007
In keeping with an ongoing commitment to
technologies at the forefront of neurosurgical
innovation, Penn Neurosurgery recently introduced
the Dynesys® system for mobile stabilization
of the lumbar spine. A new technology, the
system was designed to treat patients with chronic
intractable pain due to degenerative lumbar
compression and stenosis.
Dynesys® is a non-fusion pedicle
screw system
consisting of titanium alloy screws and synthetic
tubular spacers threaded by a central polyethylene
tension cord. The system provides dynamic
stabilization and decompression of the lumbar
spine, while preserving limited intersegmental
kinematics and reducing load to the facet joints.
“This new system
permits greater flexibility in the affected
vertebra and a
controlled range of motion, qualities that make it an ideal option for many patients.”
– William
C. Welch, MD, FACS, FICS
Chief of Neurosurgery, Pennsylvania Hospital |
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Clinical
studies suggest that the significant
improvement in mean pain and function scores
associated with the system are comparable to
those with spinal fusion. Range of motion and
disc loading have been found to be greater than
those achieved with rigid screw-rod systems.
Fewer operative complications occur because the
implantation is less invasive than most posterior
fusion procedures.
Nationally Recognized
The Department of Neurosurgery at Penn is recognized nationally
as a primary referral center for
the treatment of neck and low back pain and spinal trauma,
disc herniation syndromes, degenerative diseases
of the spine, and tumors and infections of the spine.
Penn neurosurgical specialists
perform more than 3,500
surgeries each year for a host of complex neurological
disorders. |
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The
multidisciplinary team at Penn includes specialists
in neurosurgery, rehabilitation medicine, neurology, anesthesia
and orthotics who collaborate to determine
the precise diagnosis and most appropriate procedure for
each patient's symptoms. The team also works
with psychologists, physical and occupational therapists
and social workers to ensure well-rounded care
for each patient.
Case Study
Mr. P is a 43-year-old man with unremitting lower
back pain following an automobile accident. His evaluation
demonstrated pain with movement of the lower back
and mild decreased sensation in the L5 sciatic nerve root
distribution, as well as mild weakness of the extensor
halluces longus muscle.
A straight leg-raise test was
positive on the left. Radiographic evaluation demonstrated
Grade I degenerative spondylolisthesis L4-5. Moderate
bilateral neuroforaminal stenosis at L4-5 and mild lumbar
spinal stenosis was evident. Flexion and extension films
demonstrated moderate movement at the spondylolytic
level.
Mr. P was treated with physical therapy and epidural
steroid injections. When these did not provide long -
standing relief, he requested a surgical opinion. After
careful consideration of the available options, Mr. P chose
Dynesys® for its potential to preserve movement in the
lumbar spine. The surgery included L4-5 decompressive
laminectomies, foraminotomies, and placement of the
system.
Mr. P's recovery was uneventful. He was feeling “98
percent better" at his 4 week follow-up, with excellent
relief of leg pain and very good relief of lower back pain.
His relief was long-standing. At his two-year follow-up,
he reported that he'd resumed running for the first time
in
over a decade.
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Referring Physicians: To speak with a Penn physician
or refer a patient, contact PennHealth through the secure online
referral form or by calling
1-800-789-PENN
(7366). |
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