Cosmic dynamic stabilisation
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Transcript of Cosmic dynamic stabilisation
The Cosmic System in the Treatment of the The Cosmic System in the Treatment of the Degenerative Lumbar SpineDegenerative Lumbar Spine
Christian WoiciechowskyChristian [email protected]@woiciechowsky.de
www.spine-berlin.comwww.spine-berlin.com
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
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-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
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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