Dynamic Stabilization of the Lumbar Spine using the Dynesys® System

Surgical tips for the implantation of BDYNTM dynamic stabilization system: combining spinal navigation with motion preservation for low-grade lumbar degenerative spondylolisthesis

BACKGROUND

As required in every dynamic stabilization system, the implantation of the BDYNTM device implies a perfect positioning of the screws and rods to benefit from its biomechanical properties. To achieve this goal, intra-operative imaging seems mandatory.

METHOD

Through a case report of a patient with symptomatic grade I lumbar degenerative spondylolisthesis, we present the surgical tips for the implantation of BDYNTM dynamic stabilization system under the assistance of spinal navigation Surgivisio® 2D/3D.

CONCLUSION

The pedicular screw convergence, their placement in the pedicles, and the proper alignment of the BDYNTM system placed in neutral position are important steps of the surgery. Intra-operative spinal navigation helps achieving precise and safe positioning of the dynamic stabilization BDYNTM device taking optimal advantages of its biomechanical characteristics.

Postoperative Management Strategy of Surgical Site Infection following Lumbar Dynesys Dynamic Internal Fixation

Aim

To research the incidence of surgical site infection (SSI) following lumbar Dynesys dynamic internal fixation and its management strategy.

Methods

We retrospectively analyzed all cases of lumbar Dynesys dynamic internal fixation performed from January 2010 to December 2019, and the data from patients with SSI were collected. The observational indicators included the incidence of SSI, general information of the patients, surgical details, inflammatory indicators, pathogenic bacteria, and treatment. SSI was defined as both early infection and delayed infection, and the cases were divided into Groups A and B, respectively. The relevant indicators and treatment were compared between the two groups.

Results

A total of 1125 cases of lumbar Dynesys dynamic internal fixation were followed up. Twenty-five cases of SSI occurred, and the incidence of SSI was 2.22% (25/1125). There were 14 cases of early infection (1.24%) and 11 cases of delayed infection (0.98%). Fourteen cases of early infection occurred 12.3 ± 8.3 days postoperatively (3–30), and 11 cases of delayed infection occurred 33.3 ± 18.9 months postoperatively (3–62). The inflammatory indicators of Group A were significantly higher than those of Group B (all P < 0.05), except for procalcitonin. The main infection site in Group A was located on the skin and subcutaneous tissue and around the internal instrument, while the main infection site in Group B was around the internal instrument. The main treatment for Group A was debridement and implant replacement, and the main treatment for Group B was implant removal. Summary. The incidence of SSI following lumbar Dynesys dynamic internal fixation was 2.22%, the incidence of early SSI was 1.24%, and the incidence of delayed SSI was 0.98%. If the main infection site of early infection is in the incision, debridement should be the main treatment method; if the infection site is around the internal fixation, implant replacement is recommended on the basis of debridement. Once delayed infection is diagnosed, implant removal is suggested.