Jonathan Cluett, MD, is a board-certified orthopedic surgeon with subspecialty training in sports medicine and arthroscopic surgery.
Laura Campedelli, PT, DPT, is a physical therapist currently working in New York at Morgan Stanley Children’s Hospital, an affiliate of New York Presbyterian.
Dynamic stabilization is a surgical technique designed to allow for some movement of the spine while maintaining enough stability to prevent too much movement. This type of operation is considered an alternative to lumbar fusion surgery in some situations. While dynamic stabilization surgery has become more common, it is still controversial since studies have not been able to demonstrate consistent outcomes with these techniques.
Spinal stabilization may be considered when:
If your spine is unstable, excessive motion can cause the nerves adjacent to the spinal column to become pinched. This can lead to leg pain, numbness, and weakness. Surgical stabilization of the spinal column is designed to limit abnormal motion of the spinal segments and to prevent nerve impingement.
Fusion surgery of the spine is a procedure that places the spinal structures in alignment so that post-operative bone growth between two or more adjacent spinal segments will prevent future motion. Often, metal instrumentation is used to stabilize the spinal segments while the bone eventually forms between the vertebrae.
Even when all goes well with spinal fusion, problems can arise down the road. When two spinal segments fuse, extra physical stress is transferred to the discs above and below the fusion. These adjacent segments tend to wear out more quickly, which can necessitate additional surgical procedures down the road. This is especially problematic if you are young and expect to remain active.
Dynamic stabilization may be an alternative to fusion in some situations. The instrumentation used in dynamic stabilization is designed to control the amount of motion between adjacent vertebrae, but it is not positioned to promote complete elimination of movement.
Access to the spine and removal of degenerated disc material is done similarly during dynamic stabilization surgery and during spine fusion surgery. After the preliminary steps, the procedures differ.
During a dynamic stabilization operation, your surgeon would place a dynamic stabilization device to limit motion at the affected disc level. One commonly implanted device is called Dynesys.
You would have supervised rehabilitation during your healing and recovery period after your dynamic stabilization surgery.
This procedure is used as a way to help prevent some of the problems seen with spine fusion, although the results have not been clearly demonstrated. It is important to note that long-term studies assessing the effects of dynamic stabilization have not been performed, and therefore dynamic stabilization is controversial and is still considered experimental.
In addition, there are concerns with dynamic stabilization devices, including higher rates of implant failure and loosening.
More work needs to be done to better define the role of dynamic stabilization in lumbar spine surgery. Further investigation into dynamic stabilization may help answer some of these unanswered questions.
Low back pain problems are typically treated with non-surgical interventions. However, in some circumstances, noninvasive treatments may not provide adequate relief. If you need to undergo surgery for spinal disc problems, you may also need added stabilization of the spine to prevent additional problems.
"Symposium: Dynamic Stabilization of the Lumbar Spine," Orthopedics Today International, March/April 2006.
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