gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

First experience with the topping off technique using semi-rigid stabilisation of the lumbar spine

Meeting Abstract

  • Sandro M. Krieg - Neurochirurgische Klinik, München, Deutschland
  • Anna Rienmüller - Neurochirurgie Klinikum rechts der Isar TU München, Orthopädie, München, Deutschland; Medizinische Universität Wien, Österreich
  • Balser Nele - Neurochirurgische Klinik Klinikum rechts der Isar, München, Deutschland
  • Haiko Pape - Neurochirurgische Klinik Klinikum rechts der Isar, München, Deutschland
  • Bernhard Meyer - Klinikum rechts der Isar, Technische Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocDi.01.03

doi: 10.3205/17dgnc179, urn:nbn:de:0183-17dgnc1793

Published: June 9, 2017

© 2017 Krieg et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at



Objective: Semi-rigid stabilization was introduced due to the concept of load sharing. We propose a topping-off technique leaving the most upper motion segment without anterior cage in order to reduce adjacent segment disease (ASD) by creating a smooth transition from stabilized to free motion segments. The objective of this study was to evaluate the influence of these angles on reoperations to investigate potential impacts.

Methods: We report on the first 203 patients enrolled from 2009 to 2013. Reoperation rate, VAS, ODI, RMDI, and subjective patient rating were used as outcome measures. All patients underwent pedicle screw-based semi-rigid stabilization of the lumbar spine with the Medtronic Horizon PEEK Rod®-system. All patients underwent computed tomography or x-ray after surgery. Outcome measures were evaluated 3 and 12 months after surgery.

Results: For 46.9% of patients, implantation of the PEEK rod was the first lumbar surgery while 53.1% received a PEEK rod system as revision surgery after decompression or following ASD after dynamic or rigid stabilization. A mean of 2.8 ± 0.7 (median 3) motion segments were included while 1.3 ± 0.6 (median 1) motion segments were fused. 80.6% of patients underwent TLIF in the same surgery. 78.4% of patients also received decompression. General satisfaction with the surgical result 12 months after surgery was 91.8%. Mean pain score using VAS was 7.9 ± 1.0 before and 3.4 ± 1.1 at 3 months after surgery (p<0.05), while RMDI was 15.8 ± 2.7 before and 9.8 ± 2.2 at 3 months after surgery (p<0.05). ODI was 46.0 ± 6.8 before and 28.9 ± 6.2 at 3 months after surgery (p<0.05). Concerning screw loosening, we observed a rate of 3.6% loosened screw of all screws which caused revision surgery in 8.2% of all patients 1.5 ± 1.3 years after PEEK rod surgery. Screw loosening mainly occurred in L5 (12.2%) and S1 (14.3% of all patients).

Conclusion: The PEEK rod concept including the topping of principle seems safe with high satisfaction at least in short-term follow up. Concerning future steps, longer follow up examinations are mandatory.