gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Re-OP rate after posterior dynamic stabilization of the thoraco-lumbar spine with the COSMIC® system

Meeting Abstract

  • M. Behr - Klinik und Poliklinik für Neurochirurgie, Technische Universiät München
  • A. Demetriades - Department of Neurosurgery, King's College Hospital, London
  • A. Reinke - Klinik und Poliklinik für Neurochirurgie, Technische Universiät München
  • J. Villard - Klinik und Poliklinik für Neurochirurgie, Technische Universiät München
  • B. Meyer - Klinik und Poliklinik für Neurochirurgie, Technische Universiät München
  • M. Stoffel - Klinik für Neurochirurgie, Helios Klinikum Krefeld

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocSA.09.05

DOI: 10.3205/12dgnc366, URN: urn:nbn:de:0183-12dgnc3664

Published: June 4, 2012

© 2012 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

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Objective: Dynamic devices for stabilization of lumbar degenerative instability are becoming more popular. But it is unclear, whether the use of a posterior dynamic device influences the re-OP rate compared to fusion. Therefore we investigated the re-OP rate at one single centre in a retrospective-consecutive style.

Methods: From 04/2006–12/2010 n=346 were treated using a posterior dynamic fixateur interne for degenerative lumbar instability. In n=48 patients implant-related re-OPs were performed up to 06/2011 (m=20; f=28). Median age 67 yrs. (39–78 yrs.). Median interval from first posterior dynamic stabilization to first re-OP at the dynamic device or at an adjacent level was n=14 months (range: 3–41 months). In n=9/48 patients indication for posterior dynamic stabilization was adjacent level disease due to prior instrumentation. Data-collection was performed in a retrospective-consecutive style using digital patient folder, pre- and postop CT/MR-imaging, and with telephone-interview for those, who didn't take part in a follow-up program or who chose another institution for further therapy.

Results: In n=48 (13.9%) patients of n=346 patients in total, re-OPs were done at the implanted dynamic device or at an adjacent segment. In n=48 patients n=83 motion segments (range 1–3) were instrumented at the time of first dynamic stabilization procedure. n=18 pats mono-segmental, n=25 bi-segmental and n=5 tri-segmental. Indications for re-OP within or adjacent to the stabilized segments were: n = 2 (0.6 %) spondylodiscitis n=1 (0.3%) osteoporotic fracture cranial to the hardware, n=10 (2.9%) screw-loosening, n=5 (1.4%) persistent/new low back pain, n=5 (1.4%) symptomatic protrusion/stenosis within the stabilized segment – therefrom n = 2 with additional screw-loosening, n=25 (7.2%) symptomatic degeneration in crania/caudal adjacent segment – therefrom n=4 with additional screw-loosening. N=9 patients after posterior dynamic stabilization due to ALD n=6/9 (66.7%) developed further symptomatic degeneration in an adjacent segment and in n=3/9 patients screw loosening was observed.

Conclusions: The “overall” re-OP rate of 13.9% using a dynamic posterior fixateur interne is low in relation to the observation period and the total number of observed patients – particularly a low re-OP rate due to symptomatic degeneration within an adjacent segment of 7.2% is remarkable. Posterior dynamic stabilization can be considered to be at least equivalent or superior to fusion procedure for a well selected collective.