TREATMENT OF DEGENERATIVE DISEASES OF THE LUMBAR SPINE WITH COFLEX AND DIAM DYNAMIC INTERSPINOUS IMPLANTS

Objective. To summarize own experience and to assess early results of surgical treatment of the lumbar spine degenerative disease using COFLEX and DIAM dynamic implants.

Material and Methods. Dynamic interspinous fixation was performed in 96 patients at the age of 23 to 72 years. Pathologic substrate of clinical syndromes was intervertebral disc herniation and protrusion, osteophyte, degenerative spinal stenosis, and spinal segmental instability. In 88 cases interspinous fixation was combined with spinal root decompression, in other 8 cases the adjacent segment fixation was performed in the course of spinal fusion. Clinical and radiological results of the treatment were observed during 6 months after surgery.

Results. Mean values of the Oswestry Disability Index in patients examined at 3 and 6 months postoperatively decreased till the level of minimal lesions. Interspinous fixation resulted in the intervertebral disc height increase in its posterior and, to a lesser degree, middle parts. Despite some decrease in segmental angle, there were no cases of kyphotic deformity. Flexion/extension mobility of the operated segment in a sagittal plane almost halved. The achieved correction of intersegment relations remained unchanged in 6 months after surgery. There were no complications associated with implant insertion. Radiological signs of bone tissue resorption in bone-implant interface were not observed. Reliable differences of the treatment results depending on the type of interspinous implant (COFLEX or DIAM) were not revealed.

Conclusion. The studied technique is feasible, does not assume a distruction of any anatomical spine structures, and can be widely used not only for repair, but also for prevention of segmental instability.

1. Аделт Д., Рашдорф К.И. Лечение стеноза позвоночного канала с использованием динамического межостистого имплантата «Кофлекс»: результаты 154 наблюдений // Хирургия позвоночника. 2006. № 3. С. 88–89.

2. Миронов С.П., Ветрилэ С.Т., Швец В.В. и др. Первый опыт применения межостистых стабилизирующих имплантатов при оперативном лечении остеохондроза пояснично-крестцового отдела позвоночника // Вестн. травматол. и ортопед. им. Н.Н. Приорова. 2006. № 2. С. 45–50.

3. Aota Y., Kumano K., Hirabayashi S. Postfusion instability at the adjacent segments after rigid pedicle screw fixation for degenerative lumbar spinal disorders // J. Spinal Disord. 1995. Vol. 8. P. 464–473.

4. Caserta S., La Maida G.A., Misaggi B., et al. Elastic stabilization alone or combined with rigid fusion in spinal surgery: a biomechanical study and clinical experience based on 82 cases // Eur. Spine J. 2002. Vol. 11. Suppl. 2. P. S192–S197.

5. Caserta S., Misaggi B., Peroni D., et al. Elastic stabilization combined with rigid fusion: a prevention of pathology of the border area. Proceedings of the XXIV National Congress of the Italian Spine Society // Eur. Spine J. 2001. Vol. 10. P. 352–362.

6. Etebar S., Cahill D.W. Risk factors for adjacent-segment failure following lumbar fixation with rigid instrumentation for degenerative instability // J Neurosurg. 1999. Vol. 90. Suppl. 2. P. 163–169.

7. Gardner A., Pande K.C. Graf ligamentoplasty: a 7-year follow-up // Eur. Spine J. 2002. Vol. 11. Suppl. 2. P.157–163.

8. Kaech D.L., Jinkins J.R. The interspinous “U”: a new restabilization device for the lumbar spine // In: Spinal Restabilization Procedures. Amsterdam: Elsevier Science, 2002. P. 355–362.

9. Tsai K.-J., Murakami H., Lovery G.L., et al. A Biomechanical evaluation of an interspinous device (coflex device) used to stabilise the lumbar spine // Paradigm Spine J. 2006. N 1.

10. Lee J., Hida K., Seki T., et al. An interspinous process distractor (X STOP) for lumbar stenosis in elderly patients: preliminary experiences in 10 consecutive cases // J. Spinal Disord. Tech. 2004. Vol. 17. P. 72–77.

11. Markwalder T.M., Wenger M. Dynamic stabilization of lumbar motion segments by use of Graf’s ligaments: results with an average follow-up of 7.4 years in 39 highly selected, consecutive patients // Acta Neurochir. (Wien). 2003. Vol. 145. P. 209–214.

12. Pfirrmann C.W., Metzdorf A., Zanetti M., et al. Magnetic resonance classification of lumbar intervertebral disc degeneration // Spine. 2001. Vol. 26. P. 1873–1878.

13. Schiavone A.M., Pasquale G. The use of disc assistance prostheses (Diam) in degenerative lumbar pathology: Indications, technique, and results // Ital. J. Spinal. Disord. 2003. Vol. 3. P. 213–220.

14. Schlegel J.D., Smith J.A., Schleusener R.L. Lumbar motion segment pathology adjacent to thoracolumbar, lumbar and lumbosacral fusions // Spine. 1996. Vol. 21. P. 970–981.

15. Stoll T.M., Dubois G., Schwarzenbach O. The dynamic neutralization system for the spine: a multi-center study of a novel non-fusion system // Eur. Spine J. 2002. Vol. 11. Suppl 2. P. 170–178.