Recent Advances in Techniques & TechnologyTransform Adult Spine Stabilization Surgery

Advancements in fixation techniques andtechnology are revolutionizing spinestabilization surgery for adults with

spinal column deformities.

“Spine stabilization surgery is one of medi-cine’s fastest changing specialties,” saidorthopaedic surgeon Marc Agulnick, MD,who collaborates at Winthrop-UniversityHospital with neurosurgeon Benjamin Cohen,MD, to correct adult spine deformities thatcause progressive, debilitating pain in the back or lower extremities. “The rapid evolution of our field has altered the way wepractice. New instrumentation made withstronger — yet lighter — metals, improvedtechniques and a better understanding of the biomechanics of the spine enable us toapproach patients very differently today compared with just two years ago.”

With ongoing advanced training and a clearunderstanding of the surgical innovationstransforming their specialty, Drs. Agulnick andCohen are at the forefront of their field, tailor-ing their approach to each patient’s uniquecondition. “Every deformity is different, and

every surgical approach varies to accommo-date that difference,” explained Dr. Cohen.“But our goals are the same for patients: toeliminate pressure on spinal nerves, stop the

deformity’s progression, minimize back painand neurogenic leg symptoms and finish witha balanced spine.”

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“The rapid evolution of spine stabilizationsurgery has altered the way we practice.New instrumentation made with stronger— yet lighter — metals, improved techniques and a better understanding ofthe biomechanics of the spine enable usto approach patients very differentlytoday compared with just two years ago.”

Marc Agulnick, MD

Progressive Neuroscience l Fall 2009 l 11

Beginning with careful pre-operativeevaluation and extensive surgical plan-ning to treat the deformity and ensurethat it is neurologically feasible for thepatient, Drs. Agulnick and Cohen firstdetermine the surgical approach —anterior, posterior or combined. Oncein the OR, they flank the patient, utiliz-ing implanted instrumentation to redis-tribute the stresses on the bones andkeep them aligned properly so thatbone fusion can take place.

The lengthy, arduous, complex andrisky surgery is seamlessly performedas if the two specialists were meldedinto one surgeon with four hands.Their joint efforts blend their distinc-tive skills, expertise and training intoan exceptionally productive synergythat continues through the post-opera-tive period and significantly improvesthe patient’s quality of life.

That is exactly what they did for AD, a56-year-old woman barely able to workbecause of excruciating pain caused by a thoracolumbar 52º spinal curve.“She had scoliosis that developed andprogressed during years of arthritis,”explained Dr. Agulnick. “The degenera-tive changes resulted from a viciouscycle of asymmetric loading of thespine, asymmetric degeneration andasymmetric deformity. Due to the vari-ability of the condition, degenerativescoliosis is one of the most challengingspine conditions to treat. Her non-surgical therapies had failed, she wasliving on pain medication, and herquality of life was terrible.”

In most cases, thoracic curves can betreated with a one-stage posteriorfusion and instrumentation. AD’s surgery to release and stabilize herspine, as well as relieve her pain, wasmore complex than most, and involvedthe combined approach conducted intwo stages: Stage one entailed anterioraccess to the spine and focused onreleasing the curve between the L3 segment and the sacrum; stage two,performed posteriorly three days later,addressed deformity between T10 and the pelvis. To support the bonegrafts, the surgeons used state-of-the-art instrumentation, including high-grade plastic cages in the frontand the latest pedicle screw systemsmade of the strongest metal alloys in the back.

“In the not-too-distant past, we wouldhave been restricted to using unwieldyrods, wires and hooks, with varyingresults and rigid spine stabilization,”said Dr. Agulnick. “Today, many of theobstacles of the older-generation tech-nology have been overcome with thedevelopment, refinement and strength-ening of segmental instrumentation andthe new, FDA-approved, pedicle screwsystems, which allow us to use shorterrods and fuse fewer motion segments.

“We are correcting stiffer adult curvesand restoring sagittal balance oncethought to be unachievable. And, we’regetting greater control, correction andflexibility, as well as improved fusionrates, better prevention of pseudarthro-sis and ease of post-op management.These advances are providing patientswith immediate spine stability and earli-er mobility.”

AD recovered and regained her mobili-ty in short order. After eight days inWinthrop’s surgical intensive care unit,she began rehabilitation and returned

to work four months post-operatively.She was off all pain medication bymonth six.

According to Dr. Cohen, the procedureshe and Dr. Agulnick perform areenhanced by Winthrop’s spine specialtysetup. “We have the most modernequipment, specialized microscopes andhighly trained, experienced staff,” saidDr. Cohen. “Additionally, progress inpre-operative assessment technology,anesthetic techniques, intra-operativemanagement and spinal cord monitor-ing has greatly improved our under-standing of post-operative care and theability to better handle the complexitiesof this high-risk surgery.”

For more information, call the Institutefor Neurosciences at 1-866-NEURO-RXor visit www.winthrop.org.

Pre-operative view of lumbar curve greaterthan 60o.

Post-operative pedicle screw segmentalinstrumentation construct.

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