1. Seite 1 © 2011 Schön Klinik Hybrid Dynamic Stabilization System

2. Seite 2 © 2011 Schön Klinik 5 Sizes  [24-40mm] 4 Sizes  [20-43mm]

3. Seite 3 © 2011 Schön Klinik  Consider the pedicle is roughly a cylindric structure.  The medial wall should not be perforated/passed by the trocar Pedicle Preparation with cannulated Trocar  Minimal skin incision (C-arm fluoroscopic-control)  Placement of screws in Seldinger -Technique  Cannulated Trocar

4. Seite 4 © 2011 Schön Klinik THREE- Mini-Incision- Technic

5. Seite 5 © 2011 Schön Klinik N=75, (36 m- 39 fem.) Mean age 51,3 a Range 26 –75 a

6. Seite 6 © 2011 Schön Klinik follow up n=62/75 Patients (82%), at timepoints from 3, 6, 12 and 24 months postoperativ assed by using a pain score based on VAS (range 1-10) functional outcome assed by using the ODI-Score and additionally a personal satisfaction score (school-grade 1-6) The resulting flexibility of the dynamic treated parts of the spine (ROM L2-S1) with new X Rays p.a., side and Re/Inclination

7. Seite 7 © 2011 Schön Klinik 59 patients/ n=70 after 3 months, 48 patients after 6 months, 21 patients after 12 months, 9 patients after 24 months and 4 patients after 36 months Up to now: Follow up (MW 10,11 months, range 3-36 months)

8. Seite 8 © 2011 Schön Klinik

9. Seite 9 © 2011 Schön Klinik

10. Seite 10 © 2011 Schön Klinik Very satisfied Somewhat unsatisfied Satisfied personal index (range 1-6 school grade ) middle value 2

11. Seite 11 © 2011 Schön Klinik

12. Seite 12 © 2011 Schön Klinik In two cases we had a broken dynamic coupler due to a individual measuring mistake which leaded to a overload of the system One hybrid-case with considerable screw loosening and whipping effect ( revision-pedicle plastic- dynamic enlargement adjacent level) In one case we had a misplacement of a screw, which tend to be revised Two subcutaneus seroma, through the temporary choosen modified subfascial intramuscular approach