The Cosmic System in the Treatment of the The Cosmic System in the Treatment of the Degenerative Lumbar SpineDegenerative Lumbar Spine

Christian WoiciechowskyChristian Woiciechowskychristian@woiciechowsky.dechristian@woiciechowsky.de

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Spine center BerlinSpine center Berlin

Center of excellence for Center of excellence for endoscopic & minimal invasive endoscopic & minimal invasive

spine surgeryspine surgery

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Process of spine degenerationProcess of spine degeneration

disccolaps → subluxation of the facet joints → spondylarthrosis/spondylosis → instability/deformity → stenosis

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Biomechanics of the lumbar spineBiomechanics of the lumbar spineFlexibility and neutral zoneFlexibility and neutral zone

The load-displacement curve of the spineThe load-displacement curve of the spine

The neutral zone (NZ) is the displacement at low loads.

The elastic zone (EZ) is the displacement from the end of the neutral zone to the maximum physiological load.

The range of the load-displacement curve motion (ROM) is the sum of NZ and EZ.

White and Panjabi: Clinical biomechanics of the spine, 1990.

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-8

-6

-4

-2

0

2

4

6

8

-12 -9 -6 -3 0 3 6 9 12

ROM [°]

Pain Pain

Normal

Pain

Degeneriation

DynamicStabilisation

Increase of the NZ

Flex.Ext.

NZ

“Active Zone"

Changes in the biomechanics of the lumbar Changes in the biomechanics of the lumbar spine due to degenerationspine due to degeneration

EZ EZ

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Motion preservation

Decompression, improvement of neuroloy Resolve of pain Stibilze the spine Restriction or prevention of motion

Fusion

Goals in lumbar spine surgeyGoals in lumbar spine surgey

dorsal ventral

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Problems with fusionProblems with fusion

Adjucent level instability

solutiondorsal dynamic stabilisation with motion preservation

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Dorsal dynamic systemsDorsal dynamic systems

DynesisCoflex cosmic

Rigidity Mobility

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The cosmic systemThe cosmic system

20°

20°

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Muscle splitting approach (Wiltse)Muscle splitting approach (Wiltse)

M. multifidus

M. iliocostalisM. longissimus

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Placement of the screwsPlacement of the screws

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Case exampleCase example

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Laboratory studiesLaboratory studies

Schmoelz, W. et al (2009) Eur Spine J 18: 1478-85

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Cosmic permits 35%-40% flexion / extension of the intact spine

ResultsResults

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Cosmic is more stable against rotation, than the intact spine

ResultsResults

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Case presentationsCase presentations

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Case presentationsCase presentations

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Case presentationsCase presentations

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Oswestry disability index

49,28

24,4620,59

26,58

48,70

23,86

0,00

10,00

20,00

30,00

40,00

50,00

60,00

PreOP 12 months FU 24 months FU

observation date (OP and follow up)

mea

n v

alu

e o

f o

swes

try

sco

re (

in p

erce

nt)

stabilisation without decompression stabilisation with decompression

Clinical resultsClinical results

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VAS pain scale

2,68

2,67

7,43

2,36

2,82

7,09

0

1

2

3

4

5

6

7

8

9

10

PreOP 12 months FU 24 months FU

observation date (OP and follow up)

mea

n v

alu

e o

f V

AS

pai

n s

cale

stabilisation without decompression stabilisation with decompression

Clinical resultsClinical results

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Indikations for dynamic systemsIndikations for dynamic systems

Good IndikationsGood Indikations Facett joint syndrom witgh some discogenic pain Mild Spondylarthrosis Signs of instability (segmental hyperlordosis)

Relative IndikationsRelative Indikations Spondylolisthesis Meyerding I°

Spondylolisthesen > Meyerding I°. Skoliosen. Kyphosen Stabilisierung über 3 Segmente.

KontraindikationsKontraindikations