358 - A New Interlaminar Dynamic Stabilization (IntraSpine) for the Treatmen...

#358 A New Interlaminar Dynamic Stabilization (IntraSpine) for the Treatment of Early and Late Degenerative Problems in the Lumbar Spine

Lumbar Therapies and Outcomes

Poster Presented by: A.B. Darwono

Author(s):

A.B. Darwono (1)

(1) Gading Pluit Hospital / Tarumanagara University, Orthopaedic Department, Jakarta Utara, Indonesia

Abstract

Introduction: The ultimate Clinical goal of Dynamic Stabilization using motion preservation Devices is to relieve Pain and to improve the function of the spinal motion segment (SMS). Essentially it should preserve and restore physiologic motion, while maintaining the balance and stability of the SMS by controlling motion and unloading the disk and or the facet joint. Since the Degenerative cascade can not be stopped, so the Key is :

1. Try to treat in the early stage with Dynamic stabilization or

2. Try to treat in the late stage with decompression and Dynamic stabilization.

Materials and Methods: 3 years non randomized prospective follow up study of dynamic stabilization using IntraSpine for the treatment of early and late degenerative cases. Follow up: 2 weeks, 1, 2, 3, and 6 months after surgery. The dynamic stabilization using IntraSpine was performed by single surgeon. Assessment by dynamic x-ray, MRI, Ct-scan and VAS before and after surgery.

Result: In three years 60 cases of 22 males and 38 females, average age 56.9 ( 27 - 85 years old ) were treated using IntraSpine, The variation levels of dynamic stabilization are related to the degenerative levels, from 1 to 5 levels, and from L1-2, until L5-S1. The skin incision is from 3 - 10 cm, the surgical time for 1 level with decompression is 45' to 4 hours for 4 - 5 levels. After 6 months the result is excellent : VAS from average 8.3 to 1.2 , Dynamic x-ray stable, patient can do normal activity daily living.

Discussion: The fundamental feature in the design of the new device IntraSpine is related to the anatomical reconstruction of the SMS and regarding the overturned anvil the anterior part (nose) of the device should be placed in between the laminae (Middle Column of Roy Camille) to control the load distribution and to achieve the “Sagital Balance” The interlaminar area is closer to the axis of instantaneous rotation of the SMS. The Complex Fascia Supraspinatus (CFS) is used as Natural Connector for this system, while the connector of pedicle system is metal connector. The IntraSpine is made of Medical Grade Silicone 65 shore coated by a pure PET sleeve.

Conclussion: This report shows a good result of IntraSpine and match with the goals of Dynamic stabilization:

1. Stabilize the Segmental Instability,

2. Maintain the Sagittal Balance, and

3. Restore the physiologic movement of SMS.