Motion Preservation Surgery in The Lumbar Regions of The Spine

The lumbar region of the spine is the most susceptible to pain and injury. This is due to its mobility combined with the amount of weight that it must carry with day-to-day movements. 

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When conditions affecting the lumbar spine (such as spinal stenosis and spondylolisthesis) don’t improve with non-surgical treatment, surgery may be required. Spinal fusion has been widely used over the past several decades to stabilize the spine, namely after spinal decompression surgery. 

The many downsides of spinal fusion, including reduced mobility and the risk of adjacent segment degeneration, have paved the way for better alternatives. Now, motion preservation surgery is being used in place of traditional lumbar spinal fusion for better clinical outcomes.

What is Motion Preservation Surgery?

Motion preservation surgery refers to surgical methods that can be used in place of conventional spinal fusion. As the name suggests, these methods preserve the natural movement of the spine in the affected area.

The goal of motion preservation surgery is to avoid the risks and downsides associated with spinal fusion surgery. 

Motion Preservation Surgery of The Lumbar Spine

Distinct challenges are present for motion preservation surgery of the lumbar spine. As mentioned at the beginning of this article, the lumbar spine is mobile and undergoes a significant amount of weight with normal activities. These characteristics make it difficult to stabilize the lumbar region while preserving its mobility. 

Despite these challenges, patients with spinal conditions affecting the lumbar spine now have multiple options of motion preservation surgery at their disposal, including:

  • Interspinous spacer

An interspinous space is placed in between the spinous processes at the back of the spine. It helps alleviate symptoms of spinal stenosis by creating more space in the central spinal canal and foramen. 

  • Total element replacement device

A total element replacement device is inserted after spinal decompression surgery to replace all of the elements located in the back of the spine. This provides support and pain relief for patients with spinal stenosis. 

  • Facet replacement device

A facet replacement device is also used to treat spinal stenosis, which is often caused by facet joint degeneration. This type of device takes the place of facet joints at the back of the spine for controlled motion and pain relief.  

  • Posterior dynamic stabilization device

A posterior dynamic stabilization device acts like a brace for the spine. The goal of this type of device is to allow a controlled, natural range of motion for the spine. 

Posterior dynamic stabilization devices are generally used to treat spinal stenosis, spondylolisthesis, and degenerative disc disease.   

Motion Preservation Device Example

The TOPS System from Premia Spine is a specific example of a posterior dynamic stabilization device that allows for a controlled range of motion in the treated vertebrae. The TOPS System is designed for use at a single level between L2 and L5. As a motion-preserving implant, it allows movement in flexion and extension, rotation, and lateral bending while blocking sheer forces on the lumbar spine. 

The TOPS device replaces structures removed during spinal decompression surgery, like the lamina or facet joint. It includes internal metal stoppers that take the place of the natural bony elements that acted as stoppers in axial rotation. The device’s boot and internal components replace the supraspinous and interspinous ligaments, as well as the ligamentum flavum, which naturally handle flexion. 

Clinical studies carried out since 2005 have shown that the TOPS System relieves chronic lower back and leg pain for patients suffering from moderate to severe spinal stenosis (with or without spondylolisthesis and facet arthrosis). 

Availability of Posterior Dynamic Stabilization Devices in The U.S.

The TOPS System has long been approved and used successfully in Europe and other countries across the globe. In the U.S., clinical trials for the TOPS System are currently underway.

TOPS earned the Breakthrough Device Designation from the U.S. Food and Drug Administration (FDA) in 2021. This designation will accelerate and prioritize the FDA’s review of this device during its regulatory process in the U.S.

What Are The Benefits of Motion Preservation Surgery?

Motion preservation surgery offers several benefits over conventional spinal fusion, including:

Reduced Risk of Adjacent Segment Disease

Adjacent segment disease, or ASD, occurs when the vertebrae surrounding a fused segment degenerate at a faster than normal rate. With all motion eliminated at the fused segment, the adjacent vertebrae must undergo more impact with day-to-day activities. ASD may lead to symptoms including:

  • Lower back pain
  • Pain that radiates from the lower back to the extremities
  • Neurological symptoms
  • Pain while walking and/or standing 

By preserving the patient’s range of motion in the spine, motion preservation surgery decreases the risk of ASD. 

Shorter Recovery Period

Since motion preservation surgery omits the extensive bone grafting and fusion process, it involves a shorter, less painful recovery period. It also allows for less blood loss during the procedure when compared to spinal fusion. 

Preserved Spinal Mobility

Though obvious from the procedure name, preserved spinal mobility is a key benefit of motion preservation surgery. Reduced spinal mobility is one of the largest downsides of spinal fusion, as it can have a major, negative impact on patients’ post-op quality of life. Though spinal fusion can alleviate patients’ spinal symptoms, it may also eliminate their ability to partake in their favorite activities. 

One of the prominent goals of lumbar motion preservation surgery is to create a controlled range of motion in the lumbar spine. This provides spinal stability and pain relief without significantly limiting patients’ activities after the procedure. 

Lower Risk of Needing Revision Surgery

Since motion preservation lowers the risk of injury to the adjacent spinal segments, it also lowers the odds that the patient will require revision surgery. An estimated 8% to 45% of spinal fusion patients require revision surgery. 

Motion preservation surgery is an exciting alternative to spinal fusion for patients suffering from lumbar spine conditions and disorders. Contact a spine specialist today to learn more about this treatment option.