1. Dynamic Interspinous Assisted Motion (DIAM) Compliance with NICE A.Kasis, K. Lingulta G. Reddy, T. Friesem Spinal Unit, North Tees Hospital

2. Non-rigid stablization? Non rigid stabilization of the L spine Alternative to fusion Distraction Some motion

3. First review, July 2005

4. DIAM Conforms to interspinous anatomy Minimal distrubance to segmental muscles Two independent laces

5. Devices reviewed by NICE Bronsard and Graf ligaments Dynesys systems (Pedicle screws) Mims device DIAM Wallis X stop.

6. March 2006

7. Specialist advisors Consultants nominated by their specialist society or by the Royal College Literature review Christie SD, Song JK, Fessler RG. Dynamic interspinous process technology. Spine. 2005 Aug 15;30(16 Suppl):S73-8. Stoll TM, Dubois G, Schwarzenbach O. The dynamic neutralization system for the spine: a multi-center study of a novel non-fusion system. Eur Spine J. 2002 Oct;11 Suppl 2:S170-8. Epub 2002 Sep 10. Grob D, Benini A, Junge A, Mannion AF. Clinical experience with the Dynesys semirigid fixation system for the lumbar spine: surgical and patient-oriented outcome in 50 cases after an average of 2 years. Spine. 2005 Feb 1;30(3):324-31. Rigby MC, Selmon GP, Foy MA, Fogg AJ. Graf ligament stabilisation: mid- to long-term follow-up. Eur Spine J. 2001 Jun;10(3):234-6. Markwalder TM, Wenger M. Dynamic stabilization of lumbar motion segments by use of Graf's ligaments: results with an average follow-up of 7.4 years in 39 highly selected, consecutive patients. Acta Neurochir (Wien). 2003 Mar;145(3):209-14; discussion 214.

8. Recommendations 1.Inform clinical governance 2.Patients, written information 3.Audit and review

9. Spinal unit, North Tees 10 patients (13 prosthesis) Average age 59 (38-78) 6 female

10. Indications 6 spinal stenosis 3 spinal stenosis with facet arthropathy 1 patient with 2 levels disc degenerations, not suitable fusion/disc replacement (Jehovah Witness)

11. Pre-op investigations MRI Plain X rays 2 patients had discography

12. 9 spinal rehab with no benefit 4 sacral epidural injection One nerve root block Pre-op treatment

13. Most common level L4/5 Most common size used 10 and 12 Average length of surgery about 40 minutes per prosthesis Length of stay 1.3 days per prosthesis (1-3)

14. Advantages No blood transfusion required No neurological complications No infection No spinal canal intrusion

15. Compliance with NICE All patients received NICE leaflet Notes record: 9/10 record of giving the leaflet. 10/10 record of all possible complications 10/10 record of success rate, and possible requirement of additional procedure 10/10 record of new procedure

16. Satisfaction 10/10 patients were satisfied with the procedure, at the first review in the clinic. Average follow up is 2.3 months (1.5-6)

17. Recommendations Re-audit at a longer follow up Another literature review

18. 57 y old lorry driver (Jehovah Witness), with 2 level degenerative disease, 3 months post DIAM procedure, patient returned to work 4 weeks post op.

19. Thank You