Author/Editor		Voršič, Matjaž; Bunc, Gorazd
Title		Nefuzijska dinamična stabilizacija pri degenerativnih okvarah ledvene hrbtenice: prikaz primera
Translated title		Nonfusion stabilization in the degenerative lumbar spine diseases: case report
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 78, št. 4
Publication year		2009
Volume		str. 195-202
Language		slo
Abstract		Background Modern style of living and the aging of the population increase the number of the patients with the degenerative diseases of the lumbar spine, especially in the active part of the population. Methods For the surgical treatment, different types of fusion were used in order to achieve the rigid stability of the affected motion segment. These techniques often lead to adjacent segments degeneration, therefore the development of the new dynamic systems, needing no fusion, occurred. With careful patient selection, the new operative techniques and instrumentation provide better results in these diseases. Results The results in the major centers, treating this pathology are encouraging, however being a new system, enough long-term results have to be available for proper evaluation of the method. In our department we treated 15 patients in one year, 11 of them were evaluated eight months after surgery with appropriate scales, so far with good results. Discussion Cosmic is a posterior nonfusion dynamic implant system, featuring hinged screws that provide a sufficient degree of dynamization and load sharing between the system and the vertebral column. The hinged screws are coated with bioactive calcium phosphate and connected adjacently with the rod, providing stability. The system provides a good rotational stability. The main indication for the Cosmic is symptomatic spinal stenosis accompanied by the spondylolisthesis. Conclusions Cosmic is a posterior dynamic nonfusion pedicle screw-rod system for the stabilization of the lumbar vertebral column. It represents the new step in the development of the spinal instrumentation and can efficiently replace the spondylodesis in the treatment of painful degenerative diseases of the lumbar spine.
Summary		Izhodišča S sodobnim načinom življenja in s staranjem prebivalstva se delež degenerativnih bolezni ledvene hrbtenice nenehno povečuje. Te bolezni predstavljajo velik odstotek obolevnosti aktivne populacije. Metode Do nedavnega so se pri zdravljenju degenerativnih sprememb uporabljale predvsem različne tehnike rigidne fuzije, ki so strmele k trdni stabilizaciji okvarjenega segmenta. Te tehnike so pogosto vodile v dodatne degenerativne okvare sosednjih segmentov, zato se počasi razvijajo dinamični sistemi, ki ne potrebujejo fuzije. Nove operativne tehnike in inštrumentacija prinašajo boljše rezultate pri nekaterih, skrbno izbranih merilih. Rezultati Rezultati v večjih centrih so spodbudni. Ker pa gre za novo metodo, še ne moremo ocenjevati dolgoročnih rezultatov. Na našem oddelku smo v 1. letu operirali 15 bolnikov, 11 smo jih osem mesecev po operaciji ocenili z ustreznimi ocenjevalnimi lestvicami in zaenkrat so rezultati zelo dobri. Razpravljanje Cosmic je posteriorni nefuzijski dinamični inštrumentacijski sistem, ki je sestavljen iz transpedikularnih vijakov z gibljivo glavo, kar omogoča razporeditev bremena med sistemom Cosmic in hrbtenico ter omogoča fiziološko mikromobilnost v kaudo-kranialni smeri. Vijaki, ki so prevlečeni z bioaktivnim kalcijevim fosfatom, so medsebojno povezani z vzdolžno palico, ki jih povezuje na obeh lateralnih straneh in omogoča učinkovito stabilnost. Sistem omogoča predvsem odlično rotacijsko stabilnost. Glavna indikacija za uporabo sistema Cosmic je stenoza spinalnega kanala skupaj s spondilolistezo. Zaključki Cosmic je posteriorni nefuzijski dinamični sistem, ki je nov korak v razvoju spinalne ledvene inštrumentacije in lahko učinkovito zamenja spondilodezo pri zdravljenju nekaterih degenerativnih bolezni ledvene hrbtenice.
Descriptors		LUMBAR VERTEBRAE SPONDYLOLISTHESIS SPINAL STENOSIS BONE SCREWS