Is a fusion surgery unavoidable?
Degenerative diseases of the spine can lead to strong pain. However, the nowadays widely performed fusion surgery involves disadvantages, too. New dynamic implants are leading to good long-term results.
Signs of wear and tear of the spinal column are widespread in our society.
For many people, the resulting degeneration is practically asymptomatic. These people are often active and sporty with a good muscle coat and a good balance between extensor and flexor muscles.
Painful degenerations, on the other hand, are caused by monotonous strain in everyday life, lack of activity and poor posture.
Degenerative diseases of the spine often lead to medical treatment and not seldom to surgery. In advanced states a fusion surgery, the so-called spondylodesis, has to performed relatively often. In this technique, two adjacent vertebral bodies are connected by screw-rod systems and thus stiffened. This is intended to prevent painful movement in the corresponding section. This technique has had a firm place in the surgical treatment of degenerative spinal diseases since 1948 and is still considered to be the golden standard today.
Due to increased strain on the adjacent intervertebral discs, revision surgeries have to be performed in some cases after a relatively short time already. In professional circles, the revision rate after five years is considered to be around 40 percent. That is why engineers have been working with surgeons for many years to find solutions to avoid fusion surgery.
If decompression, i.e. relief of the spinal canal and nerves, must be carried out in addition to the approach, the operation is performed from the back. In cases where this could result in hypermobility or instability, or in cases where there was an instability before the surgery already, these motion segments should be additionally strengthened or even stiffened. This raises the crucial question: How much stability is necessary to provide the patient with a painless and long-lasting result? A successful concept was established in the early 1990s with the widely used Dynesys® implant from the Swiss company Protek. This implant is still regularly used today. Dynesys® is a relatively rigid implant that shows positive results and only late degeneration of the adjacent segments.
In order to change the stiffness and adapt it to the size, activity and anatomical conditions of the patient, this idea was reworked and a new implant was created based on this experience: SpineShape offers patients whose spine has not yet suffered permanent damage dynamic stabilization of the lumbar vertebrae using flexible rods. Based on the existing wear and tear, the statics of the spine and the condition of the intervertebral discs, the specialist can decide on one of the three existing stiffnesses of the longitudinal rods. Each patient thus receives an individually adapted dynamic stabilization.
The mobility of the lower spine is maintained and in most cases there is permanent pain relief without stiffening of the vertebrae. In Switzerland, 900 patients were treated with SpineShape. The clinical results of the first six years are promising and very positive, whereas the revision rates are far below what would be expected with classic spondylodesis.
Patients describe a significant reduction in back and leg pain, often become pain-free and show good activity. Patients, who have undergone classical fusion surgery in a first approach and then receive dynamic stabilization due to adjacent segment disease, regularly describe that they do not feel SpineShape and can move more freely.
* Based on clinical results of a surgeon with in-depth experience with SpineShape, Dynesys® and classic spondylodesis.