The Dynesys Lumbar Spinal Stabilization System

Abstract

We present the positional magnetic resonance imaging findings of a prospective case series of patients undergoing surgery with the Dynesys spinal stabilization device (Zimmer, Inc., Warsaw, IN). To explore the biomechanical impact of the Dynesys device in vivo. Spinal fusion surgery is widely used for painful degenerative conditions of the lumbar spine that have not responded to conservative measures. It often produces good outcomes but can be associated with adjacent segment hypermobility that may lead to further degeneration and pain. Previous cadaveric biomechanical studies claim that the Dynesys Dynamic Spinal Stabilization System allows some lumbar movement, behaving similar to a normal spine in extension but similar to rigid fixation in flexion. Twenty-four patients with dominant low back pain, with or without leg pain, were treated with the Dynesys. All patients underwent positional magnetic resonance imaging before surgery and 9 months after surgery. Measurements were made to assess the differences at the operated level, adjacent level, and whole lumbar spine. There was a statistically significant reduction in flexion-extension range of movement of both the whole lumbar spine by 13.37 degrees (P = 0.002) and at the instrumented segments by 4.08 degrees (P < 0.001) following surgery. There was an insignificant reduction in range of movement at the level above instrumentation (P = 0.807). Mean anterior disc height at the instrumented level reduced by 0.7 mm following insertion of the Dynesys (P < 0.027). Mean posterior disc height reduced by 0.3 mm (P = 0.453). In a neutral posture, the Dynesys had no significant impact on lordosis or inclination of operated or adjacent levels. Contrary to cadaveric study findings, the Dynesys appears to restrict extension more than flexion with respect to a neutral posture. In vivo, the Dynesys Stabilization System allows movement at the instrumented level, albeit reduced, with no significant increased mobility at the adjacent segments. There was reduction of the anterior disc height without a significant increase of the posterior disc height.