Die dynamische Stabilisierung an der Wirbelsäule ist eine Möglichkeit Fusionen zu umgehen und Risike wie Anschlußinstabilität zu reduzieren

1. Spine center Berlin
Center of excellence for endoscopic &
minimal invasive spine surgery
The Cosmic System in the Treatment of the
Degenerative Lumbar Spine
Christian Woiciechowsky
christian@woiciechowsky.de
www.spine-berlin.com

2. Process of spine degeneration
disccolaps → subluxation of the facet joints → spondylarthrosis/spondylosis
→ instability/deformity → stenosis
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3. Biomechanics of the lumbar spine
Flexibility and neutral zone
The 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 loaddisplacement curve
motion (ROM) is the sum
of NZ and EZ.
White and Panjabi: Clinical biomechanics of the spine, 1990.
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4. Changes in the biomechanics of the lumbar
spine due to degeneration
Pain
Pain
Pain
Flex.
Ext.
Normal
8
EZ
NZ
EZ
6
4
Degeneriation
2
Increase
of the NZ
0
Dynamic
-2
Stabilisation
-4
-6
“Active Zone"
-8
-12
-9
-6
-3
0
3
6
9
12
ROM [°]
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5. Goals in lumbar spine surgey




Decompression, improvement of neuroloy
Resolve of pain
Stibilze the spine
Restriction or prevention of motion
Motion preservation
Fusion
dorsal
ventral
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6. Problems with fusion
Adjucent level instability
solution
dorsal dynamic stabilisation with
motion preservation
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7. Dorsal dynamic systems
Coflex
Dynesis
cosmic
Rigidity ↑
Mobility ↓
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8. The cosmic system
20
°
20°
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9. Muscle splitting approach (Wiltse)
M. multifidus
M. longissimus
M. iliocostalis
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10. Placement of the screws
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11. Case example
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12. Laboratory studies
Schmoelz, W. et al (2009) Eur Spine J 18: 1478-85
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13. Results
Cosmic permits 35%-40% flexion / extension of the intact spine
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14. Results
Cosmic is more stable against rotation, than the intact spine
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15. Case presentations
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16. Case presentations
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17. Case presentations
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18. Clinical results
Oswestry disability index
stabilisation without decompression
stabilisation with decompression
mean value of oswestry score
(in percent)
60,00
50,00
49,28
48,70
40,00
30,00
26,58
23,86
20,00
24,46
20,59
10,00
0,00
PreOP
12 months FU
24 months FU
observation date (OP and follow up)
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19. Clinical results
VAS pain scale
stabilisation without decompression
stabilisation with decompression
10
mean value of VAS pain scale
9
8
7
6
7,43
7,09
5
4
2,67
3
2,36
2,82
2
2,68
1
0
PreOP
12 months FU
24 months FU
observation date (OP and follow up)
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20. Indikations for dynamic systems
Good Indikations
 Facett joint syndrom witgh some discogenic pain
 Mild Spondylarthrosis
 Signs of instability (segmental hyperlordosis)
Relative Indikations
 Spondylolisthesis Meyerding I°
Kontraindikations




Spondylolisthesen > Meyerding I°.
Skoliosen.
Kyphosen
Stabilisierung über 3 Segmente.
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