Vertebral instability is a clinical entity which can only be defined in terms of its many functional and morphological effects and anatomopathological and pathophysiological aspects. Because vertebral instability involves proteiform features and evolves in a cyclic way, it is difficult to treat and diagnose and its course is hard to predict. Furthermore, possible iatrogenic consequences should be considered. Spine fusion has been regarded as the gold standard in the surgical treatment of instability of the lumbar spine. However, new concepts are evolving in the direction of non-fusion techniques. In fact, there is evidence that pain in vertebral instability may be load-related rather than motion-related. Moreover, there is increasing evidence of accelerated degeneration of the adjacent segment of a fused spinal segment. Dynesys is a dynamic stabilization system that aims to limit excessive motion to a parphysiological range, while neutralizing anomalous load transfer within functional spinal unit. We based our practice and clinical use of Dynesys on functional evaluation of vertebral instability with an in vivo biomechanical study by axial-loaded computed tomography (ALCT) and Cine ALCT, as well as conventional dynamic X-rays, in 32 patients. Cine ALCT findings led us to define typical pathological motion patterns that guided targeted treatment in individual patients, with good clinical results in all cases. Postoperative ALCT was also performed in 14 cases, showing elimination of anonalous movement and restoration of biomechanincs akin to that observed in normal subjects. In selected cases, neutralizing pathological motion and load transfer with a non rigid system, and the least invasive technique, enables restoration of biomechanics with good clinical results. The use of ALCT led us to a functional approach to instability. We could reveal biomechanical anomalies and their translation into dynamic images with significant anatomical and functional information. Forthermore, we could find in most cases a correlation between altered motion and symptoms, for a targeted treatment.

Scarfo', G.B., Muzii, V.F. (2014). Towards a functional treatment of lumbar vertebral instability. Restoration of the biomechanics with Dynesys. In Dynamyc stabilization of the lumbar spine with Dynesys. 20 years clinical history (pp. 41-46). Montpellier : Sauramps Medical.

Towards a functional treatment of lumbar vertebral instability. Restoration of the biomechanics with Dynesys

SCARFO', GIOVANNI BATTISTA;MUZII, VITALIANO FRANCESCO
2014-01-01

Abstract

Vertebral instability is a clinical entity which can only be defined in terms of its many functional and morphological effects and anatomopathological and pathophysiological aspects. Because vertebral instability involves proteiform features and evolves in a cyclic way, it is difficult to treat and diagnose and its course is hard to predict. Furthermore, possible iatrogenic consequences should be considered. Spine fusion has been regarded as the gold standard in the surgical treatment of instability of the lumbar spine. However, new concepts are evolving in the direction of non-fusion techniques. In fact, there is evidence that pain in vertebral instability may be load-related rather than motion-related. Moreover, there is increasing evidence of accelerated degeneration of the adjacent segment of a fused spinal segment. Dynesys is a dynamic stabilization system that aims to limit excessive motion to a parphysiological range, while neutralizing anomalous load transfer within functional spinal unit. We based our practice and clinical use of Dynesys on functional evaluation of vertebral instability with an in vivo biomechanical study by axial-loaded computed tomography (ALCT) and Cine ALCT, as well as conventional dynamic X-rays, in 32 patients. Cine ALCT findings led us to define typical pathological motion patterns that guided targeted treatment in individual patients, with good clinical results in all cases. Postoperative ALCT was also performed in 14 cases, showing elimination of anonalous movement and restoration of biomechanincs akin to that observed in normal subjects. In selected cases, neutralizing pathological motion and load transfer with a non rigid system, and the least invasive technique, enables restoration of biomechanics with good clinical results. The use of ALCT led us to a functional approach to instability. We could reveal biomechanical anomalies and their translation into dynamic images with significant anatomical and functional information. Forthermore, we could find in most cases a correlation between altered motion and symptoms, for a targeted treatment.
2014
9782840239642
Scarfo', G.B., Muzii, V.F. (2014). Towards a functional treatment of lumbar vertebral instability. Restoration of the biomechanics with Dynesys. In Dynamyc stabilization of the lumbar spine with Dynesys. 20 years clinical history (pp. 41-46). Montpellier : Sauramps Medical.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11365/977713
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