Dynamic Interlaminar Stabilization of the Lumbar Spine
Dynamic Interlaminar Stabilization of the Lumbar Spine
What is the importance of getting surgery for spinal stabilization?
This is a procedure that helps with spinal stabilization and removes pressure from discs and joints that are damaged without having to perform a fusion. When spinal fusion is performed, the spine is no longer flexible at the point where the bones are fused together. In this procedure, the spine remains mobile. The technique was originally designed in Switzerland and then developed in Germany. It has been used on patients since the mid-1990's, so it is a relatively new procedure.
Who Needs Surgery for Spinal Stabilization?
This procedure is beneficial for patients who have tried non-surgical treatments for spinal stabilization without success. If patients are young or have non-painful damage to nearby vertebrae, they may want their spine to remain mobile. In the elderly, spinal fusion may not be successful due to the poor quality of their bones, so this procedure is more likely to be beneficial.
Rarely, a portion of a bulging disc has been removed and another piece of the disc bulges out. This procedure of spinal stabilization can be used to remove the remaining disc material and prevent future problems. If the spinal canal is too narrow and pressure is being placed on the nerves, this technique can be used to slightly change the position of the spine and stabilize it. This makes more space and removes the pressure from the nerves.
Two days before your surgery for spinal stabilization, take a gentle laxative, such as colace or senna. This will help make sure your bowels are open the day you have surgery.
On the day you are scheduled for surgery it is important that you have nothing to eat. Do not eat anything after midnight on the night before surgery. Doctors and hospitals vary on how long prior to surgery you need to stop drinking water. You will be given pre-operative instructions that explain this. If you don't understand something, be sure to ask your doctor.
All of your medications will be supplied by the hospital while you are a patient, so you do not need to take your medicines to the hospital. Do take along a list of the names and the doses of the medications you take.
If you have had any scans or tests, take those to the hospital with you also.
Complications of the Surgery for Spinal Stabilization
- In elderly patients, a fusion may fail because of the poor bone quality and here again, the technique can be useful.
- In the rare case where the patient has had surgery before to remove a bulging piece of disc material (often the cause of sciatica) and a further piece of the disc comes out, the technique can be used to “decompress” the disc and prevent any future problems recurring.
- Where the spinal canal is narrowed causing pressure on the nerves (“canal stenosis”) this system may be used to slightly bend the spine forwards at the affected level or levels and stabilize it, to make a little extra space. This decompresses the nerve roots and overcomes the symptoms, usually of leg pain brought on by walking.
Surgical Procedure for Spinal Stabilization
- In the midline approach, only one incision is made over the affected area of the spine after being confirmed by an x-ray. The bones of the spine can easily be seen after the muscles are moved out of the way. Tiny instruments and a microscope are used to remove the pressure and then the dynamic stabilizer is inserted under very controlled circumstances so the normal structures are not distorted. The wound is then closed.
You will wake up from surgery for spinal stabilization in the recovery room. You will spend a short amount of time there to make sure your condition is stable. Depending on your physician's orders, you may be sent home on the same day, or you may stay in the hospital a few days.
To prevent nausea, it is important not to drink or eat too quickly following surgery. You will have intravenous fluids to prevent dehydration.
Soon after surgery for spinal stabilization, you will start physical therapy. Skilled therapists will teach you how to safely get in and out of bed and they will help you start walking. You may become dizzy or lightheaded the first few days when you get up. This is normal and will go away as you get stronger. You may also be fitted with a brace to help support your back. Your doctor will provide you with instructions on when and how long you are to wear this for spinal stabilization.
The nursing staff will treat your incisions while you are in the hospital, dressing them as needed. The nurses will also provide you with the instructions and information you need to prepare you for discharge.
Results of the Surgery for Spinal Stabilization
The majority of patients see a significant improvement in their symptoms following this surgical procedure for spinal stabilization. Recovery time from the operation may be several weeks. At the six-week follow-up appointment, many physicians or surgeons refer their patients to a physical therapy program to help re-train the back and abdominal muscles and to work on posture improvement and spinal stabilization.
Most patients have significant improvement in their symptoms after surgery. The operation itself may take several weeks to recover fully from, and thereafter a program of physiotherapy exercises is needed to retrain the spinal muscles and work on improving posture.
At follow-up appointments, patients are carefully checked and the results audited. X-rays are taken to ensure the hardware position is satisfactory and that healing has occurred.
The system and the techniques have very extensively tested and the long-term clinical results are beginning to come through and look very promising. On-going studies will hopefully prove the value of this technique over the coming years.
At follow-up appointments with their surgeon, patients are thoroughly examined and x-rays are obtained to make sure that healing is progressing and the surgical hardware is in the correct position to ensure spinal stabilization.
Because this procedure for spinal stabilization has not been used in clinical practice for many years, it is difficult to know the long-term outcome. It is a relatively new system, but it has been extensively tested and clinical trials have been positive. Studies continue to monitor its value and will be more available over the next years.