Dr. Sushil Vijay P.G Student D.

Orth Santosh Medical college & Hospital

What is Motion Preservation Spine Surgery

A relatively new perspective on preventing or treating

adjacent segment disease that occurs after a back surgery comes from proponents of motion preservation.
motion preservation surgeries are designed to allow

the intervertebral joint of the spine to continue to move after the procedure is complete.

Artificial Disc Replacement Promising Motion Preservation Technology?

In the U.S., the artificial disc replacement is the new

kid on the block as far as motion sparing spine surgeries go.

 Spinal fusion does not fit into this category of

surgeries, as spinal fusion creates stiffness, which increases the pressure on nearby joints. This raises risk for adjacent segment disease above and below the level where the surgery is done.
Examples of motion sparing surgery include (but are

not limited to) the total disc replacement, interspinous spacers such as the X-stop* for stenosis and plastic rods. *DISCUSSED LATER

 Because traditional spinal fusion surgery eliminates

the movement of the affected joint, motion preservation surgery seeks to preserve the function of the joint while still treating the injury to the spine and the associated pain.

How Does Motion Preservation Surgery Work?

Motion Preservation Surgery is a relatively new

technique, predicated on the use of a stainless steel artificial cervical disc which allows for continued natural rotation of the spine while providing both relief and treatment to the affected area.
Most often back and neck pain are caused by the

compression of the nerve because of increased pressure from the disc. Motion Preservation surgery removes the disc causing pressure on the nerve and replaces said disc with the artificial disc.

 This procedure is a multi-step process and begins by

removing the injured disc in pieces, thereby decompressing the affected nerve. After the disc is removed, small incisions are made on the upper and lower vertebrae of the injured area. These incisions are what hold the new component in place.

 Dr. Aury Nagy, M.D. was the first neurosurgeon to

perform the procedure in Nevada. He placed a PRESTIGE Cervical Disc inside the neck of a professional musician whose livelihood depended on the surgerys success.

 The PRESTIGE Cervical Disc is a unique stainless

steel device that has a two-piece ball-and-trough configuration. It is designed to maintain motion at the treated vertebral segment. It is available in a variety of sizes that allow surgeons to closely match a patient's anatomy

 The device is inserted into the disc space and attached

to the vertebrae on either side. These components function like a joint, replicating the motion (flexion, extension, side bending and rotation) of a natural intervertebral disc.

Side effects:o

Allergic reaction to the implant material Bending, breaking, movement or migration of implant material Local and/or systemic infection Pain Nerve or spinal cord injury Numbness or tingling in extremities Tear in the protective membrane of the spinal cord Loss of motion or fusion at the treated cervical level Development or progression of disease at other cervical levels Bleeding and/or blood clotting, possibly resulting in hematoma or stroke Swelling Adverse reaction to anesthesia Altered mental state Pregnancy complications, including miscarriage and/or fetal birth defects Inability to resume normal activities, including sexual activities Death *http://www.prestigedisc.com/pages/benefits_and_risks.html

X-Stop Update
The X-stop is a recent development; it

was approved by the FDA in 2005.

The X-stop works best if you don't have

any other musculoskeletal problems.

If

your stenosis is due to spondylolisthesis the X-stop is not recommended. There are a number of reasons for this, but the most important was a very high failure rate shown in a recent study. The X-Stop may even make the spondylolisthesis worse.

FOR LUMBAR SPINE

The first human implantation of lumbar artificial disc was performed by Fernstrom in 1966. He used a metal ball (SKF ball bearing) to reproduce the mechanism of the disc. However, the obtained results were poor, and the implant was withdrawn. The SB Charite prosthesis, the first FDA-approved artificial disc for clinical use in USA, was Designed in the former East Germany in the early 1980s by Schellnac and Buttner and was first implanted by Zippel in 1986.

This event triggered the development of several variety of artificial discs aiming on parameters like restoring natural motion, biocompatibility, corrosion and wear resistance, stability, strength to sustain maximum expected loads, maintain intervertebral height, preserve lordosis, and to restore the energy absorptive qualities of the native disc.

The present lumbar disc designs can be classified into four groups:
(i) composite discs: comprise of several articulating parts; often with different materials (Charite, and- ProDisc); (ii) hydraulic discs: these are designed for nucleus replacement and include an expandable fluid enclosed by a woven/porous bag (PDN); (iii) mechanical discs: which are made of articulating parts made of single type of material (Maverick, Flexicore, and Kineflex); (iv) elastic discs: include a deformable cores, usually made of elastomers or polymers attached to metallic endplates (Acroflex).

PROBLEMS WITH X - STOP

But most insurance companies regard the X-Stop as

"investigational", which means most likely they will not pay for it.

The reason for this is that there have only been a few

studies on the procedure, none of which looked at device durability, safety, pain relief and other factors over the long term

REPLACEMENT VS FUSION
People who have a disc replacement rather than a

fusion are less likely to need a second operation because of adjacent segment disease.
So far, research does suggest that people who undergo

an artificial disc replacement surgery have less chance of needing a reoperation (called revision surgery) in the future.

 For example, in a comparison analysis of three studies involving

unpublished data (the studies were done by disc manufacturers as part of the application to the FDA for approval for the devices) researchers found that for disc disease with radiculopathy at one level in the neck, both fusion and disc replacement yielded good outcomes for patients after two years.
The disc replacement was associated with a higher degree of

success in relieving nerve symptoms, and resulted in fewer revision surgeries. The analysts concluded that a disc replacement in the neck may also be associated with a lower rate of adjacent segment disease after 2 years, but they caution that more studies are needed before this can be confirmed.

 While the data on disc replacement looks good (as of

January 2012), the studies published in the U.S. have so far only followed up with patients in the short-term. Longer-term data is coming soon.

 Medtronic Inc. manufactures the device and has

received approval from the U.S. Food and Drug Administration (FDA) to market it commercially in the United States.

 The intent of these devices is to provide a better

treatment alternative than spine fusion for patients with pain and loss of function caused by specific back problems, such as lumbar spinal stenosis, facet pain, and degenerative disc disease.