Biomechanics of posterior dynamic stabilizing device (DIAM) after facetectomy and discectomy

Phillips, Frank M.; Voronov, Leonard I.; Gaitanis, I.; Carandang, Gerard; Havey, Robert M.; Patwardhan, Avinash G.

doi:10.1016/j.spinee.2006.02.003

Cited by 65 publications

(47 citation statements)

References 17 publications

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“…The DIAM device is effective in stabilizing the unstable segment, reducing the increased segmental flexion-extension and lateral bending motions observed after discectomy [28].…”

Section: Discussionmentioning

confidence: 99%

Interspinous spacers in the treatment of degenerative lumbar spinal disease: our experience with DIAM and Aperius devices

2011

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Insertion of an interspinous devices has became a common procedure for the treatment of different clinical picture of degenerative spinal disease. We present our experience in 1,575 patients with the use of two different interspinous spacers: Device for Intervertebral Assisted Motion (DIAM) and Aperius PercLID system. From 2000 through 2008, 1,315 consecutive patients underwent DIAM implantation and 260 had an Aperius PercLID procedure. The main surgical indications included: degenerative disc disease (478 patients), canal and/or foraminal stenosis (347 patients), disc herniation (283 patients), black disc and facet syndrome (143) and topping-off (64 patients). 1,100 patients underwent a single level implant and 475 had a multiple level implant. Mean operating time was 35 min for DIAM and 7 min for Aperius. Complications were detected in 20 patients (10 cases of infections, 10 fractures of the posterior spinous processes). 40 patients were subsequently treated with posterior arthrodesis (n = 30) or total disc replacement (n = 10). Patient's postoperative clinical status was rated according to the modified Macnab criteria: symptoms resolution or improvement was achieved in 1,505 patients; and unchanged or unsatisfactory results in 70. Both techniques are safe, simple and less technically demanding. These approaches appear to be an effective alternative in selected cases, although conventional posterior lumbar decompression and fusion still may be required.

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“…The DIAM device is effective in stabilizing the unstable segment, reducing the increased segmental flexion-extension and lateral bending motions observed after discectomy [28].…”

Section: Discussionmentioning

confidence: 99%

Interspinous spacers in the treatment of degenerative lumbar spinal disease: our experience with DIAM and Aperius devices

2011

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“…These implants can be divided in interspinous devices and pedicle-based devices [14]. Biomechanical studies have shown, that interspinous devices have a stabilising effect on decompressed segments in extension, but are hardly capable of stabilising a decompressed segment in axial rotation [7,13,23,26,29]. Laboratory in vitro studies of various posterior devices also mainly show a stabilising effect in flexion/extension and lateral bending and only a limited stabilising effect in axial rotation [3,18,20,[24][25][26]32].…”

Section: Introductionmentioning

confidence: 99%

Non-fusion instrumentation of the lumbar spine with a hinged pedicle screw rod system: an in vitro experiment

et al. 2009

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In advanced stages of degenerative disease of the lumbar spine instrumented spondylodesis is still the golden standard treatment. However, in recent years dynamic stabilisation devices are being implanted to treat the segmental instability due to iatrogenic decompression or segmental degeneration. The purpose of the present study was to investigate the stabilising effect of a classical pedicle screw/rod combination, with a moveable hinge joint connection between the screw and rod allowing one degree of freedom (cosmicMIA). Six human lumbar spines (L2-5) were loaded in a spine tester with pure moments of ±7.5 Nm in lateral bending, flexion/extension and axial rotation. The range of motion (ROM) and the neutral zone were determined for the following states: (1) intact, (2) monosegmental dynamic instrumentation (L4-5), (3) bisegmental dynamic instrumentation (L3-5), (4) bisegmental decompression (L3-5), (5) bisegmental dynamic instrumentation (L3-5) and (6) bisegmental rigid instrumentation (L3-5). Compared to the intact, with monosegmental instrumentation (2) the ROM of the treated segment was reduced to 47, 40 and 77% in lateral bending, flexion/ extension and axial rotation, respectively. Bisegmental dynamic instrumentation (3) further reduced the ROM in L4-5 compared to monosegmental instrumentation to 25% (lateral bending), 28% (flexion/extension) and 57% (axial rotation). Bisegmental surgical decompression (4) caused an increase in ROM in both segments (L3-4 and L4-5) to approximately 125% and approximately 135% and 187-234% in lateral bending, flexion/extension and axial rotation, respectively. Compared to the intact state, bisegmental dynamic instrumentation after surgical decompression reduced the ROM of the two-bridged segments to 29-35% in lateral bending and 33-38% in flexion/extension. In axial rotation, the ROM was in the range of the intact specimen (87-117%). A rigid instrumentation (6) further reduced the ROM of the two-bridged segments to 20-30, 23-27 and 50-68% in lateral bending, flexion/ extension and axial rotation, respectively. The results of the present study showed that compared to the intact specimen the investigated hinged dynamic stabilisation device reduced the ROM after bisegmental decompression in lateral bending and flexion/extension. Following bisegmental decompression and the thereby caused large rotational instability the device is capable of restoring the motion in axial rotation back to values in the range of the intact motion segments.

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“…13,15,25,27,31,33,34,52 However, recent evidence suggests that surgery for degenerative lumbar spine stenosis achieves better results than nonsurgical care.31 Spinal decompression and fusion have been the standard treatment for spinal instability due to degenerative disc changes with subsequent central canal and neuroforaminal stenosis and for spondylolisthesis. Spacers placed between the lumbar spinous processes have become relatively common minimally invasive surgical treatment alternatives for a variety of spinal pathologies.…”

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confidence: 99%

Failure rates and complications of interspinous process decompression devices: a European multicenter study

Gazzeri

Galarza

Neroni

et al. 2015

FOC

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OBJECT Spacers placed between the lumbar spinous processes represent a promising surgical treatment alternative for a variety of spinal pathologies. They provide an unloading distractive force to the stenotic motion segment, restoring foraminal height, and have the potential to relieve symptoms of degenerative disc disease. The authors performed a retrospective, multicenter nonrandomized study consisting of 1108 patients to evaluate implant survival and failure modes after the implantation of 8 different interspinous process devices (IPDs). METHODS The medical records of patients who had undergone placement of an IPD were retrospectively evaluated, and demographic information, diagnosis, and preoperative pain levels were recorded. Preoperative and postoperative clinical assessments in the patients were based on the visual analog scale. A minimum of 3 years after IPD placement, information on long-term outcomes was obtained from additional follow-up or from patient medical and radiological records. RESULTS One thousand one hundred eight patients affected by symptomatic 1- or 2-level segmental lumbar spine degenerative disease underwent placement of an IPD. The complication rate was 7.8%. There were 27 fractures of the spinous process and 23 dura mater tears with CSF leakage. The ultimate failure rate requiring additional surgery was 9.6%. The reasons for revision, which always involved removal of the original implant, were acute worsening of low-back pain or lack of improvement (45 cases), recurrence of symptoms after an initial good outcome (42 cases), and implant dislocation (20 cases). CONCLUSIONS The IPD is not a substitute for a more invasive 3-column fusion procedure in cases of major instability and spondylolisthesis. Overdistraction, poor bone density, and poor patient selection may all be factors in the development of complications. Preoperatively, careful attention should be paid to bone density, appropriate implant size, and optimal patient selection.

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Biomechanics of posterior dynamic stabilizing device (DIAM) after facetectomy and discectomy

Cited by 65 publications

References 17 publications

Interspinous spacers in the treatment of degenerative lumbar spinal disease: our experience with DIAM and Aperius devices

Interspinous spacers in the treatment of degenerative lumbar spinal disease: our experience with DIAM and Aperius devices

Non-fusion instrumentation of the lumbar spine with a hinged pedicle screw rod system: an in vitro experiment

Failure rates and complications of interspinous process decompression devices: a European multicenter study

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