Pedicle screw-based posterior dynamic stabilizers for degenerative spine: in vitro biomechanical testing and clinical...

Dynamic stabilization in a degenerate symptomatic spine may be advantageous compared with conventional fusion procedures, as it helps preserve motion and minimizes redistribution of loads at instrumented and adjacent segments. This article presents a systematic review of biomechanical and clinical evidence available on some of the pedicle screw based posterior dynamic stabilization (PDS) devices. Using Medline, Embase, and Scopus online databases, we identified four pedicle-screw-PDS devices for which both, biomechanical testing and clinical follow-up data are available: Graf artificial ligaments, Isobar TTL, Polyetheretherketone rods, and Dynesys. The current state-of-the-art of pedicle-screw-PDS devices is far from achieving its desired biomechanical efficacy, which has resulted in a weak support for the posited clinical benefits. Although pedicle-screw-PDS devices are useful in salvaging a moderately degenerate functionally suboptimal disc, for severe disc degeneration cases fusion is still the preferred choice. We conclude that a pedicle-screw-PDS device should aim at restoring load sharing amongst spinal elements while preserving the qualitative and quantitative nature of spinal motion, especially minimize posterior shift of the helical axis of motion. More precise and objective assessment techniques need to be standardized for in vivo evaluation of intervertebral motion and load sharing amongst spinal elements across different pedicle-screw-PDS devices.