Percutaneous Pedicle Screw Fixations

One of the most exciting areas in spinal surgery today is the non-fusion area. Surgeons and engineers are creating devices that can be implanted to treat various spine conditions without fusion, thus allowing the patient to retain at least some movement and flexibility that would otherwise be lost by fusing vertebrae together. Although fusion is still the gold standard for, for example, treatment of DDD, more and more, non-fusion products, including dynamic stabilization devices (or motion preservation devices) and total disc replacement (TDR) are becoming the treatment of choice, especially for the younger, more active patient.

Disc arthroplasty, which refers to replacement of a damaged disc with an artificial device intended to closely mimic the natural disc, is finding increased use as an alternative to spinal fusion. If it works, disc replacement seems to relieve the patient's pain while retaining more range of motion than a fusion. The theoretical advantages have not yet been clinically proven, although biomechanical testing seems to confirm the advantages, and multicenter studies of both cervical and lumbar prostheses have shown short-term results equivalent to fusion. What is not known is whether disc arthroplasty will indeed reduce the knock-on degeneration of adjacent vertebral segments, and for how long the replacement disc will remain effective, since many potential patients are under the age of 60 years. Therefore, experts have advised physicians to inform their patients that this is still a somewhat experimental procedure and that the long term effects are unknown at this time.