Lumbar Dynamic. Reinhold Knebel Product Manager
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1 Lumbar Dynamic Reinhold Knebel Product Manager
2 The DSS system provides options for dynamic and rigid stabilization to treat hypermobile segments and segments that require fusion. Allows pedicle displacement during motion Restoration of natural center of rotation Shock absorption; axial compression Control of rotation Polyaxial, pedicle screw based construct Cannulated screws MIS approach
3 DCI Implant Indications The DSS system is indicated for skeletally mature patients with degenerative disc disease (DDD) at one to three levels from L1 to S1, including conditions such as grade 1 spondylolisthesis. DDD is defined as discogenic back pain with degeneration of the disc confirmed by patient history and radiographic studies.
4 Pain through abnormal ROM Pain through Muscle-Spasm Pain through abnormal ROM Normal 8 Ext. NZ Flex. 6 4 Degenerated 2 Dynamic -2 Stabilization 0-4 ~30-50% Increased NZ ~30-50% -6-8 "Active Zone" ROM [ ]
5 Reduction of Range of Motion The spring stiffness of the dynamic coupler reduces the range of motion in the lumbar spine by ~ 40% Flexion / Extension, Axial Rotation, Lateral Bending Prof. H.-J. Wilke: Finite Elemente Analyses DSS
6 Pedicle Displacement Center of Rotation - Quality of Motion Implant must allow change in interpedicular distance from flexion to extension providing at the same time "physiologic" stiffness to the segment. A1 B1 C1 C1 A2 B2 Extension Flexion Cunningham et. al (2006) Lumbar Spine Kinematics. SAS 6, Montreal.
7 Pedicle Displacement Inner coupler mechanism allows 2mm pedicle displacement to maintain natural center of rotation. Non-physiological motion is limited Hypermobility at the end range of motion (flexion and extension) is avoided. Cunningham et. al (2006) Lumbar Spine Kinematics. SAS 6, Montreal.
8 Maintenance of Center of Rotation Inner spring mechanism allows 2mm displacement. In combination with the spring design the natural center of rotation is maintained. Prof. H.-J. Wilke: Finite Elemente Analyses DSS
9 Kinematic Analysis of first 6 DSS-Patients:
10 Modular Design - Components Dynamic Coupler Breaking Nut Spacer Washer Pedicle Screw Fusion Coupler Material: Titanium 6- aluminum 4-vanadium alloy (ISO ).
11 Modular Design - Assembly
12 Pedicle Screws Cannulated screws to support minimally invasive applications Tissue sparing, paraspinal intermuscular approach Thread for spacer and nut trapezoidal thread in upper region Torx attachment for elongation lever and counter torque instrument Screwdriver attachment parallel outer diameter conical core blunt tip cannulation parallel core
13 Pedicle Screws Ø5mm Ø6mm Ø7mm different screw configurations
14 Modular Design - Dynamic and Fusion Coupler Dynamic Modular Design Fusion 4 Sizes [26-40mm] 3 Sizes [28-40mm]
15 Hybrid Solutions Modularity of system allows combination of fusion and dynamic stabilization. Pathologies can be addressed individually by motion segment. Adjacent segments are protected. Dynamic Coupler Fusion Coupler
16 Dynamic Coupler - Implant Features Spring effect allows controlled, dynamic motion; Overload protected Adjustable in length; one turn = 0.5mm 4 Sizes mm mm mm mm Polyaxial connection through couplerspacer interface
17 Dynamic Coupler Sectional view
18 Fusion Coupler - Implant Features Telescoping feature allows precise length adjustment; short assemblies possible Breaking nut for secure fixation 3 Sizes mm mm mm Polyaxial connection through coupler-spacer interface
19 Assembly - Monosegmental Recommended orientation for optimized fatigue strength Caudal Cranial
20 Assembly - Fusion Coupler The fixed portion of the fusion coupler has to be placed in low position
21 Polyaxial Positioning Polyaxial positioning of +/ possible through the coupler-spacer interface. Ideal in cases of L5/S ,5 12,5 12,5 12,5
22 Sterile Packaging Coupler Double blister package Coupler (single packed) Screw sets 2 screws 2 washers 2 spacers 2 breaking nuts Screw Set Variety of 17 implants 10 screws sets 4 dynamic couplers 3 fusion couplers
23 Instrument Overview Pedicle preparation Measuring/ Coupler adjustment Assembly / tightening
24 Instrument Tray Pedicle preparation/ screw insertion Measuring/ coupler adjustment Implant positioning/ tightening
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