Background: Our purpose was to evaluate the efficacy of the extrapendicular approach for unilateral percutaneous vesselplasty in dealing with Kummell disease patients. Methods: Twenty-seven patients undergoing vesselplasty at our institution were enrolled in the study. Vesselplasty was performed using percutaneous extrapendicular technique. Pain, restoration of vertebral body height, and cement leakage were evaluated in the process. Results: Substantial pain relief was attained in all the patients. The visual analogue scale improved significantly from pre-to postoperation (P , .05), and remained unchanged at every follow-up. The anterior vertebral body heights were significantly corrected after operation (P , .05). No cement leakage was found. Conclusion: This new technique of vesselplasty offers statistically significant benefits in Kummell disease patients. It also makes vesselplasty feasible, safe, and effective.
Introduction
The ultimate Clinical goal of Dynamic Stabilization using motion preservation Devices is to relieve Pain and to improve the function of the spinal motion segment (SMS). Essentially it should preserve and restore physiologic motion, while maintaining the balance and stability of the SMS by controlling motion and unloading the disk and or the facet joint. Since the Degenerative cascade cannot be stopped, so the Key is: 1. Try to treat in the early stage with Dynamic stabilization or 2. Try to treat in the late stage with decompression and Dynamic stabilization.
Materials and Methods
Three years nonrandomized prospective follow-up study of dynamic stabilization using IntraSpine for the treatment of early and late degenerative cases. Follow-up: 2 weeks, 1, 2, 3, and 6 months after surgery. The dynamic stabilization using IntraSpine was performed by single surgeon. Assessment by dynamic X-ray, MRI, Ct-scan, and VAS before and after surgery.
Results
In 3 years, 67 cases of 23 males and 44 females, average age 56.9 (27 - 85 years old), were treated using IntraSpine. The variation levels of dynamic stabilization are related to the degenerative levels, from 1 to 5 levels, and from L1-2, until L5-S1. The skin incision is from 3 to 10 cm, the surgical time for 1 level with decompression is 45 to 4 hours for 4 to 5 levels. After 6 months, the result is excellent: VAS from average 8.3 to 1.2, dynamic X-ray stable, patient can do normal daily activity.
Discussion The fundamental feature in the design of the new device IntraSpine is related to the anatomical reconstruction of the SMS and regarding the overturned anvil the anterior part (nose) of the device should be placed in between the laminae (Middle Column of Roy Camille) to control the load distribution and to achieve the “Sagital Balance” The interlaminar area is closer to the axis of instantaneous rotation of the SMS. The Complex Fascia Supraspinatus (CFS) is used as Natural Connector for this system, while the connector of pedicle system is metal connector. The IntraSpine is made of Medical Grade Silicone 65 shore coated by a pure PET sleeve
Conclusion
This report shows a good result of IntraSpine and match with the goals of Dynamic stabilization: 1. Stabilize the Segmental Instability, 2. Maintain the Sagittal Balance, and 3. Restore the physiologic movement of SMS.
Disclosure of Interest
None declared
Multilevel spine degeneration with deformity should be described in 3 column theory of lumbar degenerative cascade to detect completely the degenerative damage or deformator
Theory of degenerative spine deformity is a combination between 2 factors :
- spine stabilizer ( disc, 2 facet joints, anterior and posterior longitudinal ligament, supraspinatus ligament and multifidus muscle )
- spine deformator ( degenerative damage )
Gold standard is open surgery to remove deformator, but this will sacrifice the stabilizer, then need an artificial stabilizer or fusion
Concept of Minimally invasive Endoscopic spine surgery is removing the deformator only, while still preserving the stabilizer, then no fusion is needed
After removing deformator, the stabilizer will be refunctioned again and deformity is corrected naturally
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