[Emerging Spine Surgery Technologies] Nonfusion stabilization of the degenerative lumbar spine (Cosmic posterior dynamic stabilization)

[Justin]

Journal of Neurosurgery: Spine, Aug 2011, Vol. 15, No. 2, Pages 151-158

Nonfusion stabilization of the degenerative lumbar spine

Alberto Maleci, M.D.¹, Rafael Donatus Sambale, M.D.², Michele Schiavone, M.D.³, Franz Lamp, M.D.⁴, Fahir Özer, M.D.⁵, andArchibald von Strempel, M.D., D.Eng.^6
1Dipartimento di Scienze Neurologiche e Cardiovascolari, University of Cagliari; ³Ospedali Riuniti Azienda Ospedaliera Universitaria di Foggi, Foggia, Italy; ²Wirbelsäulenchirurgie mit Querschnittgelähmtenzentrum, Orthopädische Klinik Hessisch Lichtenau, Germany; ⁴Neurochirurgischen Abteilung, Krankenanstalt, Wien; ⁶Department for Orthopaedic Surgery, Academic Teaching Hospital Feldkirch, Austria; and ⁵Department of Neurosurgery, Vehbi Koç Foundation American Hospital, Istanbul, Turkey. ©1944-2011 by the American Association of Neurosurgeons


Abbreviations used in this paper: AP = anteroposterior; IVS = intervertebral space; ODI = Oswestry Disability Index; PLF = posterolateral fusion; PLIF = posterior lumbar interbody fusion; VAS = visual analog scale.

Object
The goal of this study was to assess whether a stable but nonrigid nonfusion implant can stabilize the spine in degenerative diseases and also prevent instability following decompression. Instrumented spondylodesis is a recognized surgical treatment in degenerative disease of the lumbar spine. However, pain can develop at the bone graft donor site and the operative trauma can be very stressful in elderly patients, and it is suspected that there may be increased degenerative changes in the adjacent segments. In 2002, a nonrigid but rotationally stable pedicle screw and rod system was introduced, which could be used without additional fusion (referred to hereafter as the Cosmic system).

Methods
A total of 139 patients with degenerative disease of the lumbar spine underwent spinal stabilization with the Cosmic system without additional spondylodesis. Seventy patients had an additional decompression. The minimum follow-up was 2 years. The perioperative course, the clinical results, and the erect anteroposterior and lateral radiographs were recorded and compared with the preoperative data. The data were obtained from 6 different spine centers in Europe and documented on an Internet platform.

Results
The Oswestry Disability Index score improved from 48.9% to 22.5%, and the visual analog scale score decreased from 7.3 to 2.5. Lumbar lordosis did not change, nor did the adjacent disc height. Eleven patients underwent revision, 4 of them for implant failure. Of the 139 patients, 110 assessed the result as excellent, very good, or good; 24 as fair; and 5 as poor. A total of 122 patients would undergo surgery again. There were no significant differences between patients with or without an additional decompression.

Conclusions
The Cosmic system is a stable but nonrigid posterior nonfusion system. Implant complications are low and the clinical outcome is good. Longer follow-up is necessary to confirm the 2-year results.

[Gilbert P]

HI Justin

I can relate to this Sounds like Coflex?

Gil

[Justin]

HI Justin

I can relate to this Sounds like Coflex?

Gil

Hey Gil,

The Cosmic is similar to Coflex in application.