What is Dynamic Stabilization?
Dynamic stabilization of the lumbar spine stands in contrast to the rigid spinal instrumentation where screws are placed in to the vertebra or connected to rigid rods used to rigidly fix the spinal stenosis. Instead, Dynamic stabilization of the lumbar spine procedure allows the use of spinal screws attached to a flexible rod so that the spine can be stabilized with some retention of motion and no fusion is required; therefore, the name ‘Dynamic Stabilization’.
Dynamic stabilization is the choice of surgery for patients that are interested in having non-fusion and motion preservation procedures for the lumbar spine.
Dynamic stabilization is a technology that is being developed to provide stability to a lumbar spine exhibiting instability causing intractable low back pain. The origin of back pain is most commonly associated with degenerative disc disease but can also be associated with lumbar facet disease. The facets are a paired set of joints that are present at every level in the spine between the vertebrae. Dynamic stabilization devices treat pain caused by both degenerative disc and facet disease by supporting and controlling the motion around the painful segment.
Similar to a spinal fusion, a dynamic stabilization uses screws, rods and wires to hold structural parts of the spine, like discs and vertebrae, in place. The difference between the two procedures is that after a spinal fusion, a bone graft forces two vertebrae to fuse together, causing the spine to lose mobility. Dynamic stabilization makes use of flexible prosthetic materials in an attempt to preserve the normal function of the spine, allowing it to extend and flex as usual.
Reasons to Prefer Dynamic Stabilization over Other Fusions
- Any spinal fusion even if done technically correctly can result in failure of fusion, which we call pseudoarthrosis. Failure of fusion often results in poor outcomes and often requires additional surgeries.
- Equipment problems vary from screw breakage or loosening. Fusion also entails loss of mobility. Dynamic stabilization can also cause a reduction in mobility but typically not a significant degree.
- Although, many surgeons are using various bone graft substitutes, the fusion success rate is not as high as when one uses the patient’s bone, usually taken from the iliac crest. Dynamic stabilization avoids a bone graft donor site which is another advantage over the other fusion methods.
- Fusion surgeries take longer and involve greater blood loss than dynamic stabilization.
- The average time for the fusion to heal is approximately 3 months; whereas, a dynamic stabilization patient is out of the brace is almost half of that time which is approximately 6 weeks.
- Some fusion patients may develop problems in adjacent levels of the fusion, called ‘adjacent segment disease’. Although we can’t say this doesn’t happen in dynamic stabilization patients, it is much less common.
- The fusion process causes irreversible changes to the spine, where as dynamic stabilization is a reversible process, and theoretically the rods and screws could be removed without any irreversible changes.
Who is a Candidate for Dynamic Stabilization?
The dynamic stabilization surgery may be suitable for you if:
- Non-surgical methods have failed to achieve pain relief and a return to normal activities.
- You don’t smoke or drink, and aren’t obese. Patients with these behaviors are poor candidates for dynamic stabilization or rather any kind of surgery.
- You have an active lifestyle and a strong desire to maintain or resume that lifestyle.
- You have spinal stenosis and spondylolisthesis.
- You are between ages 18 and 65.
- Your MRI shows black discs.
- You have lower back pain and degenerative disc disease.
What to Expect in the Recovery Period Following Dynamic Stabilization?
Many patients will be released from care the same day following dynamic stabilization procedure, though some may be required to stay a day or two for observation, depending on their progress, healing, and other underlying conditions. For example, smokers often have a much slower healing period. If there are additional procedures done during your surgery, these will also add to the recovery time required.
Most patients are able to return to their normal routines within six weeks after dynamic stabilization of the lumbar spine procedure, but this varies considerably from one patient to another.
It is thought that non-fusion dynamic stabilization surgery is a safe procedure corresponding to fusion surgery, even in elderly patients with adjacent segment pathology (ASP). After a diagnosis is made, conservative treatment is usually attempted first, with back surgery seen by most physicians and patients as a last resort. Many patients report finding relief from back pain and related symptoms after a full course of conservative options such as rest; physical therapy; medication, both over-the-counter and prescription; lifestyle changes like diet and exercise; epidural steroid injections. If weeks or months of the above-mentioned conservative treatments are not effective to regain an acceptable quality of life, a physician or specialist will usually consider surgery. It is always advisable to have a detailed discussion with your spine surgeon before deciding on the plan of treatment.
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