Cosmic dynamic stabilisation

The Cosmic System in the Treatment of the The Cosmic System in the Treatment of the Degenerative Lumbar SpineDegenerative Lumbar Spine

Christian WoiciechowskyChristian [email protected]@woiciechowsky.de

www.spine-berlin.comwww.spine-berlin.com

Spine center BerlinSpine center Berlin

Center of excellence for Center of excellence for endoscopic & minimal invasive endoscopic & minimal invasive

spine surgeryspine surgery


Process of spine degenerationProcess of spine degeneration

disccolaps → subluxation of the facet joints → spondylarthrosis/spondylosis → instability/deformity → stenosis


Biomechanics of the lumbar spineBiomechanics of the lumbar spineFlexibility and neutral zoneFlexibility and neutral zone

The load-displacement curve of the spineThe load-displacement curve of the spine

The neutral zone (NZ) is the displacement at low loads.

The elastic zone (EZ) is the displacement from the end of the neutral zone to the maximum physiological load.

The range of the load-displacement curve motion (ROM) is the sum of NZ and EZ.

White and Panjabi: Clinical biomechanics of the spine, 1990.


-8

-6

-4

-2

0

2

4

6

8

-12 -9 -6 -3 0 3 6 9 12

ROM [°]

Pain Pain

Normal

Pain

Degeneriation

DynamicStabilisation

Increase of the NZ

Flex.Ext.

NZ

“Active Zone"

Changes in the biomechanics of the lumbar Changes in the biomechanics of the lumbar spine due to degenerationspine due to degeneration

EZ EZ


Motion preservation

Decompression, improvement of neuroloy Resolve of pain Stibilze the spine Restriction or prevention of motion

Fusion

Goals in lumbar spine surgeyGoals in lumbar spine surgey

dorsal ventral


Problems with fusionProblems with fusion

Adjucent level instability

solutiondorsal dynamic stabilisation with motion preservation


Dorsal dynamic systemsDorsal dynamic systems

DynesisCoflex cosmic

Rigidity Mobility


The cosmic systemThe cosmic system

20°

20°


Muscle splitting approach (Wiltse)Muscle splitting approach (Wiltse)

M. multifidus

M. iliocostalisM. longissimus


Placement of the screwsPlacement of the screws


Case exampleCase example


Laboratory studiesLaboratory studies

Schmoelz, W. et al (2009) Eur Spine J 18: 1478-85


Cosmic permits 35%-40% flexion / extension of the intact spine

ResultsResults


Cosmic is more stable against rotation, than the intact spine

ResultsResults


Case presentationsCase presentations






Oswestry disability index

49,28

24,4620,59

26,58

48,70

23,86

0,00

10,00

20,00

30,00

40,00

50,00

60,00

PreOP 12 months FU 24 months FU

observation date (OP and follow up)

mea

n v

alu

e o

f o

swes

try

sco

re (

in p

erce

nt)

stabilisation without decompression stabilisation with decompression

Clinical resultsClinical results


VAS pain scale

2,68

2,67

7,43

2,36

2,82

7,09

0

1

2

3

4

5

6

7

8

9

10

PreOP 12 months FU 24 months FU

observation date (OP and follow up)

mea

n v

alu

e o

f V

AS

pai

n s

cale

stabilisation without decompression stabilisation with decompression

Clinical resultsClinical results


Indikations for dynamic systemsIndikations for dynamic systems

Good IndikationsGood Indikations Facett joint syndrom witgh some discogenic pain Mild Spondylarthrosis Signs of instability (segmental hyperlordosis)

Relative IndikationsRelative Indikations Spondylolisthesis Meyerding I°

Spondylolisthesen > Meyerding I°. Skoliosen. Kyphosen Stabilisierung über 3 Segmente.

KontraindikationsKontraindikations

Health & Medicine

Cosmic dynamic stabilisation