Dynamic Neutralisation System for the Spine or "Dynesys" is designed to permit the stabilizing of a spinal segment, and off loading of the disc and facet joints. Some movement still occurs and therefore all the stress is not passed on to the segment above or below as occurs in a spinal fusion. The hope is that with dynesys the effect of a spinal fusion can be obtained without causing adjacent levels to fail.
The spine is approached through a midline incision or two parallel incisions each side of the spine. The muscles are mobilized to expose the bone.
To stabilize the spine screws are inserted into the bone and connected using a flexible although stiff cord and spacer system. X-ray control is used to minimize the risk of incorrect placement of the screws. The implant supports the spine stabilizing it and reducing the load through the discs.
The wound is closed with absorbable sutures leaving a scar with no cross hatching and no need for suture removal. Sometimes a drain is used and will be removed 1-2 days post-op. Occasionally the suture ends require trimming.
After the operation you will be encouraged to mobilize as soon as possible with the assistance of physiotherapists and nurses. Once mobile enough to manage at home you can be discharged.
You will be give instructions with regard ongoing mobilization and physiotherapy. An outpatient appointment will be arranged.
Many patients experience a significant reduction in their back pain following stabilisation. Some pain and discomfort will persist but will hopefully be more manageable than pre - operatively. Sometimes despite apparently successful surgery no improvement is obtained.
In order to monitor the results of surgery you will be asked to complete outcome questionnaires from time to time.
Most patients do not suffer any adverse problems. Occasionally complications do occur and can require further treatment.
Nerve damage is rare during surgery. If it occurs it can cause areas of numbness, pins and needles and weakness. Neuralgic pain can also be troublesome.
Cauda equina syndrome is very rare and occurs when the nerves to the bowel and bladder are affected. Any numbness around the bottom or problems with passing stool or water should be reported immediately.
Scar tissue can form around the nerve root tethering the nerve causing ongoing pain. Occasionally further surgery is required to free up the nerve.
Infections can occur in the wound and rarely deep around the implant. These can be treated usually with antibiotics but occasionally require surgical cleaning, debridement and removal of the implant.
Damage to the lining of the nerve root (Dura) can result in a leak of fluid (csf). This is usually noticed and repaired at the time of surgery. A short period of bed rest is advised after the operation. Rarely the leak persists and has to be repaired surgically.
Bleeding can be troublesome and is controlled at the time of surgery. Rarely bleeding continues post operatively and a second procedure is required to control it. Haematomas (collections of blood in tissues) may require surgical drainage.
Metalwork failure can occur and may need replacing or removing. Sometimes the screws come loose in the bone. If the implant fails it can be removed returning the spine close to its preoperative state. Alternatively the stabilisation can be converted into a fusion.
Adjacent levels of the spine take increase strain as a result of the stabilisation and can degenerate causing further problems in the future. The concept of flexible stabilisation is that the risk of adjacent level disease is reduced.
Anaesthetic complications will be explained by your anaesthetist.
Please be assured that every effort is made to avoid the complications listed and any others which can very rarely occur.
If you have any questions or wish to discuss things further please ask at any time. It is important that you have all the information you require about your procedure, and we will assist you in every way possible.
MR ANDREW HOWARD
Consultant Spinal and Orthopaedic Surgeon
Ref No DS0804