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Spine Surgery pp 109-116 | Cite as

Lumbar Non-Fusion Techniques

  • Michael StoffelEmail author
Chapter

Abstract

Degeneration of the functional spinal unit can lead to back pain and – in case of nerve root irritation – sciatica. Spinal fusion, i.e. spondylodesis, has evolved as standard treatment against the painful mobility that may accompany disc arthrosis, degenerative segmental instability, and spondylolisthesis. If neural tissue is compressed, direct surgical decompression represents standard of treatment. During the last years, several non-fusion techniques (AKA: dynamic techniques) arose in spine surgery as alternative for spinal fusion and direct decompression, respectively. The following case illustrations are meant to elucidate clinical situations, in which the use of traditional techniques should be weighed up against non-fusion techniques. The clinical decisions will be justified by scientific evidence.

References

IPD

  1. 1.
    Ghiselli G, Wang JC, Bhatia NN, et al. Adjacent segment degeneration in the lumbar spine. J Bone Joint Surg Am. 2004 Jul;86-A(7):1497–503.CrossRefGoogle Scholar
  2. 2.
    Fritzell P, Hägg O, Nordwall A, Swedish Lumbar Spine Study Group. Complications in lumbar fusion surgery for chronic low back pain: comparison of three surgical techniques used in a prospective randomized study. A report from the Swedish lumbar spine study group. Eur Spine J. 2003;12(2):178–89.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Lurie JD, Tosteson TD, Tosteson A, Abdu WA, Zhao W, Morgan TS, Weinstein JN. Long-term outcomes of lumbar spinal stenosis: eight-year results of the spine patient outcomes research trial (SPORT). Spine (Phila Pa 1976). 2015;40(2):63–76.CrossRefGoogle Scholar
  4. 4.
    Overdevest GM, Jacobs W, Vleggeert-Lankamp C, Thomé C, Gunzburg R, Peul W. Effectiveness of posterior decompression techniques compared with conventional laminectomy for lumbar stenosis. Cochrane Database Syst Rev. 2015;(3).Google Scholar
  5. 5.
    Moojen WA, Arts MP, Bartels RH, Jacobs WC, Peul WC. Effectiveness of interspinous implant surgery in patients with intermittent neurogenic claudication: a systematic review and meta-analysis. Eur Spine J. 2011;20(10):1596–606.CrossRefGoogle Scholar
  6. 6.
    Wu AM, Zhou Y, Li QL, Wu XL, Jin YL, Luo P, Chi YL, Wang XY. Interspinous spacer versus traditional decompressive surgery for lumbar spinal stenosis: a systematic review and meta-analysis. PLoS One. 2014;9(5):e97142.CrossRefGoogle Scholar
  7. 7.
    Meyer B, Baranto A, Schils F, Collignon F, Zoega B, Tan L, LeHuec JC; NICE Trial Study Group. Percutaneous Interspinous Spacer vs Decompression in Patients with Neurogenic Claudication: An Alternative in Selected Patients?. Neurosurgery. 2017.Google Scholar

TDR

  1. 8.
    Hellum C, Johnsen LG, Storheim K, Nygaard OP, Brox JI, Rossvoll I, et al. Surgery with disc prosthesis versus rehabilitation in patients with low back pain and degenerative disc: two year follow-up of randomised study. BMJ. 2011;342:d2786.CrossRefGoogle Scholar
  2. 9.
    Hellum C, Berg L, Gjertsen Ø, Johnsen LG, Neckelmann G, Storheim K, et al. Adjacent level degeneration and facet arthropathy after disc prosthesis surgery or rehabilitation in patients with chronic low back pain and degenerative disc: second report of a randomized study. Spine (Phila Pa 1976). 2012;37(25):2063–73.CrossRefGoogle Scholar
  3. 10.
    Jacobs W, Van der Gaag NA, Tuschel A, de Kleuver M, Peul W, Verbout AJ, Oner FC. Total disc replacement for chronic back pain in the presence of disc degeneration. Cochrane Database Syst Rev. 2012.Google Scholar
  4. 11.
    Siepe CJ, Heider F, Wiechert K, Hitzl W, Ishak B, Mayer MH. Mid- to long-term results of total lumbar disc replacement: a prospective analysis with 5- to 10-year follow-up. Spine J. 2014;14(8):1417–31.CrossRefGoogle Scholar
  5. 12.
    Plais N, Thevenot X, Cogniet A, Rigal J, Le Huec JC. Maverick total disc arthroplasty performs well at 10 years follow-up: a prospective study with HRQL and balance analysis. Eur Spine J. 2017.Google Scholar

Pedicle-screw based systems

  1. 13.
    Abdu RW, Abdu WA, Pearson AM, Zhao W, Lurie JD, Weinstein JN. Reoperation for recurrent intervertebral disc herniation in the spine patient outcomes research trial: analysis of rate, risk factors, and outcome. Spine (Phila Pa 1976). 2017;42(14):1106–14.CrossRefGoogle Scholar
  2. 14.
    Watters WC 3rd, Resnick DK, Eck JC, Ghogawala Z, Mummaneni PV, Dailey AT, Choudhri TF, Sharan A, Groff MW, Wang JC, Dhall SS, Kaiser MG. Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 13: injection therapies, low-back pain, and lumbar fusion. J Neurosurg Spine. 2014;21(1):79–90.CrossRefGoogle Scholar
  3. 15.
    Wang JC, Dailey AT, Mummaneni PV, Ghogawala Z, Resnick DK, Watters WC 3rd, Groff MW, Choudhri TF, Eck JC, Sharan A, Dhall SS, Kaiser MG. Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 8: lumbar fusion for disc herniation and radiculopathy. J Neurosurg Spine. 2014;21(1):48–53.CrossRefGoogle Scholar
  4. 16.
    Stoll TM, 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;11(Suppl 2):S170–8. Epub 2002 Sep 10PubMedPubMedCentralGoogle Scholar
  5. 17.
    Maleci A, Sambale RD, Schiavone M, Lamp F, Özer F, von Strempel A. Nonfusion stabilization of the degenerative lumbar spine. J Neurosurg Spine. 2011;15(2):151–8.  https://doi.org/10.3171/2011.3.SPINE0969. Epub 2011 May 13.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of NeurosurgeryHelios Klinikum KrefeldKrefeldGermany

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