Dynamic Stabilization

Dynamic stabilization of the lumbar spine involves two different types of procedures, with one of them being a total disc replacement either in the lumbar or cervical spine.  The other form of dynamic stabilization is a technology that is being developed to provide stability to a lumbar spine that is exhibiting instability causing intolerable and intractable low back pain.  The premise behind dynamic stabilization is to address back pain that is being caused by degenerative disc disease or facet arthroprathy, which is back pain caused by lumbar facet disease.  The facets are a paired set of joints that are present at every level in the spine between the vertebrae.  Dynamic stabilization devices treat pain caused by both degenerative disc and facet disease by supporting and controlling the motion around the painful segment.

Dynamic stabilization involves placing screws into the pedicle of the vertebral body at the level above and below the level with degenerative disc disease or facet disease.  Instead of rigid devices used in spinal fusion surgery, such as fixed screws and titanium rods, dynamic stabilization involves incorporating non-rigid devices such as bendable rods or elastic bands that are inserted into the pedicle screws.  The flexible connections between the screws allow some motion to take place at the diseased level.  However, due to the stabilizing effect of these devices the patient theoretically should have decreased low back pain after the initial healing period of the surgery.  These devices are also better suited for younger patients for which a fusion surgery would take away range of motion or portend adjacent segment disease.  Dynamic stabilization is not a good option for older patients with osteoporotic bone. Dynamic stabilization is also more indicated for low back pain, though the results of any surgical intervention for axial low back pain is mixed at best, with at most 60% of patients experiencing good relief of their back pain.

Although the initial results are promising, this new technology has only short term results on patients in the United States. The dynamic stabilization devices currently approved by the Food and Drug Administration were approved for fusion only.  Patients should consult surgeons who perform this procedure to see if they are candidates and should conduct a thorough research on their own to determine if this treatment is right for them.