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Pedicle screw-based posterior dynamic stabilization: literature review.
Dilip K Sengupta1, Harry N Herkowitz
1Department of Orthopedics, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA.
Advances in Orthopedics
|December 11, 2012
Summary
Posterior dynamic stabilization (PDS) devices for low back pain lack clear design rationale and evidence. Implant failures led to market withdrawals, highlighting the need for better understanding and classification of lumbar instability.
Area of Science:
- Spine surgery
- Orthopedic biomechanics
- Spinal instrumentation
Background:
- Posterior dynamic stabilization (PDS) devices are intended for mechanical low back pain.
- Numerous PDS devices lack biomechanical rationale and clinical efficacy data.
- Implant failure is a frequent complication, causing market withdrawal of some devices.
Purpose of the Study:
- To present the current understanding of lumbar motion segment instability.
- To propose a classification for clinical instability.
- To describe clinical experiences with pedicle screw-based PDS devices.
Main Methods:
- Review of current understanding of lumbar instability.
- Development of a proposed instability classification.
- Description of clinical outcomes with specific PDS devices.
Main Results:
- Identified a lack of evidence and rationale for many PDS devices.
- Proposed a novel classification for lumbar instability.
- Detailed clinical experience with pedicle screw-based PDS systems.
Conclusions:
- Further research is needed to establish biomechanical rationale and clinical evidence for PDS devices.
- A standardized classification of instability is crucial for device development and patient selection.
- Clinical experience suggests challenges and areas for improvement in current PDS technology.
