Dynamic Stabilization of the Lumbar Spine

Article written by Kevin Yoo, MD

There are two options currently available for patients that are interested in having non-fusion, motion preservation procedures for the lumbar spine. The first is lumbar artificial disc replacement technology. The second is dynamic stabilization of the lumbar spine. The former topic will be covered in another article as the focus of this piece will be on the latter.

Dynamic stabilization is a technology that is being developed to provide stability to a lumbar spine that is exhibiting instability causing intolerable and intractable low back pain. The source of back pain is most commonly associated with degenerative disc disease but can be also associated with lumbar facet disease. The facets are a paired set of joints that are present at every level in the spine between the vertebrae. Dynamic stabilization devices treat pain caused by both degenerative disc and facet disease by supporting and controlling the motion around the painful segment.

The procedure is performed in the operating room, and typically requires a two to three day hospitalization. During the surgical procedure, screws are inserted into the pedicle and vertebral bodies above and below the diseased level. Non-rigid devices (bendable rods, elastic bands) are then inserted into or onto these screws. The flexible connections between the screws allow some motion to take place at the diseased level. However, due to the stabilizing effect of these devices the individual treated with this procedure should have less pain.

These devices are most useful for younger patients by maintaining flexibility in their backs. It is not a good device for patients who are older, have osteoporotic bones, or who have fused on their own with aging and do not have flexible backs. The treatment has greatest success in treating back pain, particularly discogenic (pain due to disc degeneration) back pain but can also treat leg pain in select cases. One final advantage of this treatment is that if these devices fail to support a diseased and degenerated lumbar spine, the patient and physician continue to have the surgical option of a lumbar fusion.

Although the initial results are promising, this new technology has only short term results on patients in the United States. The dynamic stabilization devices currently approved by the Food and Drug Administration were approved for fusion only. Patients should consult surgeons who perform this procedure to see if they are candidates and should conduct a thorough research on their own to determine if this treatment is right for them.