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.
Recommendations 1.Inform clinical governance 2.Patients, written information 3.Audit and review
Spinal unit, North Tees 10 patients (13 prosthesis) Average age 59 (38-78) 6 female
Indications 6 spinal stenosis 3 spinal stenosis with facet arthropathy 1 patient with 2 levels disc degenerations, not suitable fusion/disc replacement (Jehovah Witness)
Pre-op investigations MRI Plain X rays 2 patients had discography
9 spinal rehab with no benefit 4 sacral epidural injection One nerve root block Pre-op treatment
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)
Advantages No blood transfusion required No neurological complications No infection No spinal canal intrusion
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
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)
Recommendations Re-audit at a longer follow up Another literature review
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.