• Klaus John Schnake, Stefan Schaeren, and Bernard Jeanneret.
• Center for Musculosceletal Surgery, Department of Orthopedic Surgery and Traumatology, Charité-Universitätsmedizin Berlin, Berlin, Germany.
• Spine. 2006 Feb 15;31(4):442-9.

Study DesignProspective clinical study.ObjectiveTo test whether elastic stabilization with the Dynesys system (Zimmer Spine, Minneapolis, MN) provides enough stability to prevent further progression of spondylolisthesis as well as instability after decompression for spinal stenosis with degenerative spondylolisthesis.Summary Of Background DataIn spinal stenosis with degenerative spondylolisthesis, decompression and fusion is widely recommended. However, patients have donor site pain. In 1994, a dynamic transpedicular system (Dynesys) was introduced to the market, stating that stabilization is possible without bone grafting.MethodsA total of 26 patients (mean age 71 years) with lumbar spinal stenosis and degenerative spondylolisthesis underwent interlaminar decompression and dynamic stabilization with the Dynesys system. Minimum follow-up was 2 years. Operative data, clinical outcome, and plain and flexion/extension radiographs were obtained and compared to preoperative and postoperative data.ResultsMean leg pain decreased significantly (P < 0.01), and mean walking distance improved significantly to more than 1000 m (P < 0.01). There were 5 patients (21%) who still had some claudication. A total of 21 patients (87.5%) would undergo the same procedure again. Radiographically, no significant progression of spondylolisthesis could be detected. The implant failure rate was 17%, and none of them were clinically symptomatic.ConclusionsIn elderly patients with spinal stenosis with degenerative spondylolisthesis, dynamic stabilization with the Dynesys system in addition to decompression leads to similar clinical results as seen in established protocols using decompression and fusion with pedicle screws. It maintains enough stability to prevent further progression of spondylolisthesis or instability. With the Dynesys system, no bone grafting is necessary, therefore, donor site morbidity can be avoided.

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