motion preservation spine surgery

7/29/2019 Motion Preservation Spine Surgery

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Dr. Sushil Vijay

P.G Student D.Orth

Santosh Medical college & Hospital


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What is Motion Preservation Spine SurgeryA relatively new perspective on preventing or treating

adjacent segment disease that occurs after a backsurgery comes from proponents of motionpreservation.

motion preservation surgeries are designed to allow

the intervertebral joint of the spine to continue tomove after the procedure is complete.


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Artificial Disc Replacement Promising

Motion Preservation Technology? In the U.S., the artificial disc replacement is the new

kid on the block as far as motion sparing spine

surgeries go.


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Spinal fusion does not fit into this category ofsurgeries, as spinal fusion creates stiffness, whichincreases the pressure on nearby joints. This raises

risk for adjacent segment disease above and below thelevel where the surgery is done.

Examples of motion sparing surgery include (but are

not limited to) the total disc replacement,interspinous spacers such as the X-stop* for stenosisand plastic rods.

*DISCUSSED LATER


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Because traditional spinal fusion surgery eliminatesthe movement of the affected joint, motionpreservation surgery seeks to preserve the function ofthe joint while still treating the injury to the spine andthe associated pain.


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How Does Motion Preservation

Surgery Work? Motion Preservation Surgery is a relatively new

technique, predicated on the use of a stainless steelartificial cervical disc which allows for continued

natural rotation of the spine while providing bothrelief and treatment to the affected area.

Most often back and neck pain are caused by the

compression of the nerve because of increasedpressure from the disc. Motion Preservation surgeryremoves the disc causing pressure on the nerve andreplaces said disc with the artificial disc.


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This procedure is a multi-step process and begins byremoving the injured disc in pieces, therebydecompressing the affected nerve. After the disc isremoved, small incisions are made on the upper andlower vertebrae of the injured area. These incisions arewhat hold the new component in place.


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Dr. Aury Nagy, M.D. was the first neurosurgeon toperform the procedure in Nevada. He placed aPRESTIGE Cervical Disc inside the neck of aprofessional musician whose livelihood depended onthe surgerys success.


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The PRESTIGE Cervical Disc is a unique stainlesssteel device that has a two-piece ball-and-troughconfiguration. It is designed to maintain motion at thetreated vertebral segment. It is available in a variety ofsizes that allow surgeons to closely match a patient'sanatomy


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The device is inserted into the disc space and attachedto the vertebrae on either side. These componentsfunction like a joint, replicating the motion (flexion,extension, side bending and rotation) of a naturalintervertebral disc.


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Side effects:-o Allergic reaction to the implant material Bending, breaking, movement or migration of implant material Local and/or systemic infection Pain Nerve or spinal cord injury Numbness or tingling in extremities Tear in the protective membrane of the spinal cord Loss of motion or fusion at the treated cervical level Development or progression of disease at other cervical levels Bleeding and/or blood clotting, possibly resulting in hematoma or stroke Swelling Adverse reaction to anesthesia Altered mental state

Pregnancy complications, including miscarriage and/or fetal birth defects Inability to resume normal activities, including sexual activities Death

*http://www.prestigedisc.com/pages/benefits_and_risks.html


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X-Stop Update

The X-stop is a recent development; itwas approved by the FDA in 2005.

The X-stop works best if you don't haveany other musculoskeletal problems.

If your stenosis is due tospondylolisthesis the X-stop is not

recommended. There are a number ofreasons for this, but the most importantwas a very high failure rate shown in arecent study. The X-Stop may even makethe spondylolisthesis worse.


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FOR LUMBAR SPINEThe first human implantation of lumbar artificial disc was performedby Fernstrom in 1966. He used a metal ball (SKF ball bearing) toreproduce the mechanism of the disc.However, the obtained results were poor, and the implant was

withdrawn.

The SB Charite prosthesis, the first FDA-approved artificial disc forclinical use in USA, was Designed in the former East Germany in theearly 1980s by Schellnac and Buttner and was first implanted by Zippelin 1986.

This event triggered the development of several variety of artificialdiscs aiming on parameters like restoring natural motion,biocompatibility, corrosion and wear resistance, stability, strength tosustain maximum expected loads, maintain intervertebral height,

preserve lordosis, and to restore the energy absorptive qualities of thenative disc.


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The present lumbar disc designs can be

classified into four groups:(i) composite discs: comprise of several articulating parts;often with different materials (Charite, and- ProDisc);

(ii) hydraulic discs: these are designed for nucleus

replacement and include an expandable fluid enclosed by awoven/porous bag (PDN);

(iii) mechanical discs: which are made of articulating partsmade of single type of material (Maverick, Flexicore, and

Kineflex);(iv) elastic discs: include a deformable cores, usually madeof elastomers or polymers attached to metallic endplates(Acroflex).


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PROBLEMS WITH X - STOP But most insurance companies regard the X-Stop as

"investigational", which means most likely they willnot pay for it.

The reason for this is that there have only been a few

studies on the procedure, none of which looked atdevice durability, safety, pain relief and other factorsover the long term


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REPLACEMENT VS FUSION People who have a disc replacement rather than a

fusion are less likely to need a second operationbecause of adjacent segment disease.

So far, research does suggest that people who undergoan artificial disc replacement surgery have less chance

of needing a reoperation (called revision surgery) inthe future.


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For example, in a comparison analysis of three studies involvingunpublished data (the studies were done by disc manufacturersas part of the application to the FDA for approval for the devices)researchers found that for disc disease with radiculopathy at one

level in the neck, both fusion and disc replacement yielded goodoutcomes for patients after two years.

The disc replacement was associated with a higher degree ofsuccess in relieving nerve symptoms, and resulted in fewer

revision surgeries. The analysts concluded that a discreplacement in the neck may also be associated with a lower rateof adjacent segment disease after 2 years, but they caution thatmore studies are needed before this can be confirmed.


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While the data on disc replacement looks good (as ofJanuary 2012), the studies published in the U.S. have sofar only followed up with patients in the short-term.Longer-term data is coming soon.


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Medtronic Inc. manufactures the device and hasreceived approval from the U.S. Food and DrugAdministration (FDA) to market it commercially in theUnited States.


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The intent of these devices is to provide a bettertreatment alternative than spine fusion for patientswith pain and loss of function caused by specific back

problems, such as lumbar spinal stenosis, facet pain,and degenerative disc disease.

motion preservation spine surgery

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