Seite 1 © 2011 Schön Klinik Hybrid Dynamic Stabilization System.

Seite 1© 2011 Schön Klinik

Hybrid Dynamic Stabilization System

Percutaneus-mini-open Surgical Technique

Dr. E. MayerSpine CenterBad Aibling/Traunstein, Germany


Modular Design

Dynamic Fusion

5 Sizes

· [24-40mm]

4 Sizes

· [20-43mm]

Modular Design - Dynamic and Fusion Coupler


Cave Pedicle preparation· Consider the pedicle is roughly a

cylindric structure.

· The medial wall should not be perforated/passed by the trocar

Pedicle Preparation with cannulated Trocar· Minimal skin incision

(C-arm fluoroscopic-control)

· Placement of screws in Seldinger -Technique

Advanced-Technique• Percutaneus Surgical Technique

· Cannulated Trocar


After placing the implant guides – Insertion of the dynamic coupler

Advanced-Technique- Hybrid Fusion/rigid/dynamic/TLIFTHREE- Mini-Incision- Technic


Clinical, prospective and radiographic analysis after dynamic

and hybrid treatment of Fusion in the lumbar spine with DSS™ (timeframe 6/2008 bis 08/2011 )

Studydesign

Study Population

N=75, (36 m- 39 fem.)

Mean age 51,3 a

Range 26 –75 a


Clinical Outcomes:

follow up n=62/75 Patients (82%),

at timepoints from 3, 6, 12 and 24 months postoperativ

assed by using a pain score based on VAS (range 1-10)

functional outcome assed by using the ODI-Score

and additionally a personal satisfaction score (school-grade 1-6)

The resulting flexibility of the dynamic treated parts of the spine (ROM L2-S1) with new X Rays p.a., side and Re/Inclination


59 patients/n=70 after 3 months,

48 patients after 6 months,

21 patients after 12 months,

9 patients after 24 months and

4 patients after 36 months

Up to now:

Follow up (MW 10,11 months, range 3-36 months)


Visual analogue scale- VAS

Pre 3 m 6 m 12 m 24 m 36 m0

1

2

3

4

5

6

7

8

7.4

3.1 3.13.3

2.72.9

4.1

1.1 1.21.5

0.4 0.5

4.6

1.4

11.2

2.22

Low Back PainPain Right LegPain Left Leg


ODI Prä ODI 3 Mo ODI 6 Mo ODI 12 Mo ODI 24 Mo ODI 36 Mo0

10

20

30

40

50

60

70

63.1

31

27.4

26 22 22.8

Oswestry Disability Index- ODI


68%/n=42

28%/n=174%/n=3)

Very satisfied

Somewhat unsatisfied

Satisfaction Rate

Satisfied

personal index (range 1-6 school grade) middle value 2


In-/Reclination – (Ø avarage ROM F/E )

6m 12m 24m 36m

ROM avarage single dynamic 3.1 1.9 2.1 2

0.25

0.75

1.25

1.75

2.25

2.75

3.25

Avarage ROM- single dynamic segment

Sq

uar

e-g

rad

e°


Complications

In two cases we had a broken dynamic coupler due to a individual

measuring mistake which leaded to a overload of the system

One hybrid-case with considerable screw loosening and

whipping effect ( revision-pedicle plastic- dynamic enlargement adjacent level)

In one case we had a misplacement of a screw, which tend to

be revised

Two subcutaneus seroma, through the temporary choosen modified

subfascial intramuscular approach

Seite 1 © 2011 Schön Klinik Hybrid Dynamic Stabilization System.

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