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61st Annual Meeting of the German Society of Neurosurgery (DGNC) as part of the Neurowoche 2010
Joint Meeting with the Brazilian Society of Neurosurgery on the 20 September 2010

German Society of Neurosurgery (DGNC)

21 - 25 September 2010, Mannheim

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Posterior dynamic stabilization of the thoracolumbar spine with the COSMIC®-system – 24 months FU

Meeting Abstract

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  • Michael Behr - Klinik und Poliklinik für Neurochirurgie, Technische Universität München, Deutschland
  • Andreas Reinke - Klinik und Poliklinik für Neurochirurgie, Technische Universität München, Deutschland
  • Carsten Stüer - Klinik und Poliklinik für Neurochirurgie, Technische Universität München, Deutschland
  • Bernhard Meyer - Klinik und Poliklinik für Neurochirurgie, Technische Universität München, Deutschland
  • Michael Stoffel - Klinik und Poliklinik für Neurochirurgie, Technische Universität München, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 61. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC) im Rahmen der Neurowoche 2010. Mannheim, 21.-25.09.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocP1784

doi: 10.3205/10dgnc255, urn:nbn:de:0183-10dgnc2552

Published: September 16, 2010

© 2010 Behr et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

Text

Objective: COSMIC® (Ulrich) is a dynamic screw-rod system for the thoracolumbar spine. It provides stability against rotation and translation while maintaining flexibility in the sagittal plane. This study describes our experience in a prospective observational design.

Methods: Data collection completed in 95/103 treated patients (median FU: 24 months, mean age 65 years (30–88 y), 66 females/37 males). Indication for COSMIC® was painful degenerative instability (Th11-S1). Dynamic stabilization was performed as first tier surgery in n=43 and as second tier therapy in n=60 cases. Pre-/postoperative CT-scans/radiographs (2 planes/flexion/extension) were performed in all patients. Clinical assessment using standard scales was acquired prospectively in pre-defined time intervals (VAS, ODI, SF36).

Results: In 103 patients 162 motion segments (1–3) were instrumented (n=3/512 screws needed primary revision, no hardware breakage). n=47 patients achieved mono-segmental, n=47 bi-segmental and n=9 tri-segemental instrumentation. Additional decompression was performed in n=86 cases. Significant postoperative pain relief could be documented with the VAS and ODI. (VAS preOP 65±1 to last FU 20±2; ODI preOP 51%±1 to 17%±2) and SF36 demonstrated a significant improvement in physical (pre-op:41, last FU:45) and mental health (pre-op:44, post-op:46). n=84/95 patients were satisfied with the treatment after 2 years. n=17 Patients needed revision surgery due to problems within or adjacent to the instrumented segments. (n=1 osteoporotic fracture in an adjacent vertebra, n=3 re-decompression within the instrumented segment, n=8 symptomatic degeneration of an adjacent segment, n=3 insufficient improvement with dynamic device, n=2 infection). Of those n=8 patients with symptomatic degeneration of an adjacent segment n=2 had received mono-segmental (4% of all mono-segmental) , n=5 bi-segmental (11%) and n=1 tri-segmental (11%) stabilization. Of those n=8 patients with symptomatic degeneration of an adjacent segment, n=6 (75%) initially presented with a multisegmental degeneration with spondylolisthesis before dynamic stabilization.

Conclusions: Dynamic stabilization with COSMIC® achieved a significant improvement of pain, mobility and quality of life. An expected re-operation rate of 16,5 % and a low risk for intraoperative complications are encouraging facts. This method is best for patients with mono-segmental instability without spondylolithesis. A prospective randomized trial (spondylodesis vs. dynamic stabilization) is warranted.