Riequilibrio non artrodesi: trattamento funzionale della stenosi/instabilità vertebrale lombare

RE-EQUILIBRATION NOT ARTHRODESIS: THE FUNCTIONAL TREATMENT OF LUMBAR VERTEBRAL STENOSIS/INSTABILITY. There is evidence to support that stenosis and vertebral instability are two aspects of a process, the progressive and cyclic nature of which is not widely considered. The term "vertebral instability" is used in a non rigorous manner by exponents of highly invasive spinal surgery and arthrodesis is still considered the most effective therapy. However, attitudes may be beginning to change. We tackled the problem of vertebral lumbar stenosis/instability from a functional point of view, correlating the morphological alterations wiht the functional ones and considering them not as "excessive" but as "anomalous" movements. We assessed this condition in 26 patients by conventional methods and by biomechanical study "in vivo" with Axial-Loaded Computed Tomography (ALCT) wich enabled elementary dynamic modifications (EDMs) and complex dynamic modifications (CDMs) to be determined, revealing the biomechanical anomalies and their translation into dynamic images with a high anatomical and functional information. All patients underwnet "dynamic neutralisation" with the Dynesys(TM) system. The system controls vertebral dynamics, neutralising anomalous movements by opposing compressive forces through the elistic spacers, while tension in the cords limits elastic return, determining the resting position of the system. This treatment was based on our convinction that "preservation and restoration" of spinal function is better than "demolition and immobilisation". The clinical and functional results were good in all cases, confirming the validity of our approach and indication.