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    History of Spine Instrumentation

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    Syarif
    This document provides a history of spinal instrumentation and discusses various techniques that have been developed over time. It begins by outlining common spinal disorders and treatment approaches. Key developments discussed include the first spinal fusion in 1911, Harrington's rod and hook system from the 1950s, Luque's segmental fixation using sublaminar wires in the 1970s, and pedicle screw instrumentation introduced by Roy Camille in the 1960s. The document also reviews various posterior and anterior instrumentation systems such as Cotrel-Dubousset, Moss-Miami, Isola, Dwyer, and Zielke. In summary, it traces the evolution of spinal instrumentation from early fusion techniques to modern segmental fixation using pedicle screws

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    History of Spine Instrumentation

    Uploaded by

    Syarif
    215 views35 pages
    This document provides a history of spinal instrumentation and discusses various techniques that have been developed over time. It begins by outlining common spinal disorders and treatment approaches. Key developments discussed include the first spinal fusion in 1911, Harrington's rod and hook system from the 1950s, Luque's segmental fixation using sublaminar wires in the 1970s, and pedicle screw instrumentation introduced by Roy Camille in the 1960s. The document also reviews various posterior and anterior instrumentation systems such as Cotrel-Dubousset, Moss-Miami, Isola, Dwyer, and Zielke. In summary, it traces the evolution of spinal instrumentation from early fusion techniques to modern segmental fixation using pedicle screws

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    This document provides a history of spinal instrumentation and discusses various techniques that have been developed over time. It begins by outlining common spinal disorders and treatment approaches. Key developments discussed include the first spinal fusion in 1911, Harrington's rod and hook system from the 1950s, Luque's segmental fixation using sublaminar wires in the 1970s, and pedicle screw instrumentation introduced by Roy Camille in the 1960s. The document also reviews various posterior and anterior instrumentation systems such as Cotrel-Dubousset, Moss-Miami, Isola, Dwyer, and Zielke. In summary, it traces the evolution of spinal instrumentation from early fusion techniques to modern segmental fixation using pedicle screws

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    215 views35 pages

    History of Spine Instrumentation

    Uploaded by

    Syarif
    This document provides a history of spinal instrumentation and discusses various techniques that have been developed over time. It begins by outlining common spinal disorders and treatment approaches. Key developments discussed include the first spinal fusion in 1911, Harrington's rod and hook system from the 1950s, Luque's segmental fixation using sublaminar wires in the 1970s, and pedicle screw instrumentation introduced by Roy Camille in the 1960s. The document also reviews various posterior and anterior instrumentation systems such as Cotrel-Dubousset, Moss-Miami, Isola, Dwyer, and Zielke. In summary, it traces the evolution of spinal instrumentation from early fusion techniques to modern segmental fixation using pedicle screws

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    HISTORY OF SPINAL

    INSTRUMENTATION
    Mohamad Hidayat
    Andhika Yudistira
    SPINAL DISORDERS

    Trauma
     Fractures, Whiplash injury, etc.

    Tumor
    Infection & Inflammatory Disease
    Deformity
     Scoliosis, spondylolisthesis, degenerative lumbar kyphosis, etc.

    Cervical & Low-back Pain


     Degenerative disease, such as disc herniation, stenosis,
    spondylolisthesis, etc.
    TREATMENT OF SPINAL DISORDERS
    Conservative Treatment
     Degenerative disease
     Stable fracture
     Mild deformity

    Surgical Treatment
     Failed conservative treatment
     Unstable fracture (dislocation)
     Progressive deformity
    CRANE ANALOG IN
    SPINE BIOMECHANICS
    GOALS OF SPINAL INSTRUMENTATION
     To support the spine when its structural integrity is severely
    compromised (iatrogenic, traumatic, infectious, or tumorous, etc).
    CORRECTION  SPINAL STABILITY
     To prevent progression or to maintain the achieved profile after
    correction of spinal deformities (scoliosis, kyphosis,
    spondylolisthesis).
    MAINTAIN STABILITY AFTER CORRECTION
     To alleviate or eliminate pain originating from various anatomical
    structures by achiving fusion or stiffening spine segments and thereby
    diminishing movement.
    ENHANCE SPINAL FUSION
    THE EMERGE OF SPINAL FUSION &
    INTRUMENTATION
     Fred Albee and Russell Hibbs
    published the first spinal fusion in
    1911, for progressive deformities from
    tuberculosis.
     In 1914, Hibbs described operative
    fusion and cast correction for the
    treatment of Idiopathic Scoliosis.
     Spinal fusion has now been extended
    to treat various spinal conditions
    including scoliosis, kyphosis,
    fracture/dislocations, spondylolisthesis,
    and intervertebral disc disease.
    TYPES OF FUSION
    FACTORS FOR CONSIDERATION
    IN SPINE FUSION
    Biologic Factors
     Local Factors:
     Soft tissue bed, Graft recipient site preparation, Radiation, Tumor and
    bone disease, Growth factors, Electrical or ultrasonic stimulation
     Systematic Factors:
     Osteoporosis, Hormones, Nutrition, Drugs, Smoking

    Graft Factors
     Material, Mechanical strength, Size, Location

    Biomechanical Factors
     Stability, Loading
    SPINAL INSTRUMENTATION TYPES

    Implantation Method:
     Wiring, Hooks, Screws

    Vertebra  Rods vs. Plates

    Spinal Level:
    Graft
     Cervical, Thoracolumbar

    Vertebra Position:
     Anterior vs. Posterior
    Pedicle screw instrumentation Instrumentation
    CERVICAL SPINE INSTRUMENTATION
    THORACOLUMBAR SPINE INSTRUMENTATION
    POSTERIOR SPINAL INSTRUMENTATION

     Paul Harrington
     Eduardo Luque
     Hartshill
     Roy Camille
     Magerl
     Moss Miami
     Isola
     Subroto Sapardan
     Steffee
     Etc.
    PAUL HARRINGTON – 1950S

    Hook & Rod system


     Consisted of a rod and a hook
    at either end of the spine.
     Performing distraction
    mechanism across the rod, as
    well as compression hooks and
    rods, to partially reduce spinal
    deformities.
     However, Harrington system
    did not address normal spinal
    alignment, particularly sagittal
    plane.
    PAUL HARRINGTON - 1973
    • In 1973, Dr. Harrington published an 11 year follow-up of 578 patients who were
    treated with spinal instrumentation.

    • The average correction of the scoliosis curve in the frontal plane was 54%. He
    published a 4% rate of pseudarthrosis or non-union which was a significant
    improvement when compared with previous fusions performed without instrumentation.

    • These techniques were not without significant complications which included fracture
    or failure of the instrumentation as well as degeneration or instability affecting
    portions of the spine above or below the instrumentation

    • The distraction forces of the Harrington instrumentation tended to decrease the amount
    of lumbar lordosis (swayback) which led some patients to develop a “flat-back
    syndrome”

    • Hook dislodgement and rod breakage also proved to be troublesome complications.


    EDWARDO LUQUE - 1973
     Known as the first
    Segmental Spinal
    instrumentation/fixation.
     Using two rod system in
    posterior spine, and attached to
    spinal bones with wires
    (sublaminar wires) at each level
    of spine.
     Purpose : to increase number of
    fixation points and to obviate the
    need for a postoperative cast /
    brace.

    Hybrid system : Paul Harrington (Texas) + Edwardo Luque (Mexico), referred to as


    the TEX-MEX surgery. Using rod and sublaminar wires.
    HARTSCHILL RECTANGLE

     Luque sublaminar wire


    modification
     Although the corrective power of sublaminar wires was
    well-appreciated, many surgeons had reservations in using
    them.
     Reports of neurologic injury resulting either from direct
    trauma or from epidural hematoma.
     In addition, revision surgery to alter sublaminar wiring is
    problematic.
     Drummond et al.developed a method for segmental
    fixation using a button-wire implant passed through the
    base of the spinous process.
     This technique does not provide as strong fixation as do
    sublaminar wires.
     It avoids, however, passing anything into the spinal canal
    and thus reduces the risk of direct neurologic injury.
     Some pundits referred to the procedure as the “chicken-
    Luque” procedure.
    POSTERIOR LUMBAR INSTRUMENTATION
    MAGERL’S SCREW

    Translaminar / Transarticular Screws in Lumbar Spine


    ROY CAMILLE – 1963 &
    1970
     In 1963, Raymond managed a 17-old
    girl who had severe dislocation of
    the fourth and fifth lumbar vertebrae
    and cauda equina syndrome as the
    result of a traffic accident.
     She had had a laminectomy
    previously at another hospital,
    performed by the neurosurgical "The reduction was easy, but I had no
    team more spinous processes, I had no
    more laminae, and the wires and Wilson
    plates we had at this time were not helpful.
    So I had to do something, I tried to
    stabilize the spine with two Scherman
    plates, implanting screws where I could. I
    was an anatomist and I knew about the
    pedicle; I understood immediately that a
    good location to have an implant fixed
    to the spine was the pedicle. That is how
    I started with this surgery the first time."
    PEDICLE AS A SITE FOR SEGMENTAL SPINE
    FIXATION
     Pedicle screws presented many advantages when compared with other
    tools for spinal fixation.
     Pedicle screws are biomechanically superior as a point of fixation
    compared with hook- or wire-rod constructs and can be placed into
    the sacrum, an area to which fixation is otherwise difficult.
     In addition, they can be placed even after a laminectomy has been
    performed and can be positioned without entering the spinal canal.
     This advantage allowed for the massive proliferation of spinal
    instrumentation into the area of degenerative spinal disorders.
    COTREL-DUBOUSSET SYSTEM – 1980S
     The CD instrumentation system
    allowed for multiple fixation
    points along the spine using a
    variety of hook (laminar/pedicle)
    and rod combinations.
     This instrumentation system
    allowed for correction of the
    spine in the coronal, sagittal, and
    axial planes (rotation) during
    spinal reconstructions.
     Gradually develop using
    sublaminar wire (hybrid)
    DEVELOPMENT OF CD SYSTEM
     Texas Scottish Rite Hospital  The following decade saw the
    introduction of numerous, similar
    (TSRH) System. dual-rod systems like Moss-Miami
     It was similar to the CD system and Isola.
    in its use of multiple hooks and  The last decade has seen the
    introduction of numerous
    cross links systems that operate with the
    same design principles, with a
    shift toward the use of polyaxial
    screws that make coupling of the
    fixation points to the rods easier.
     Today’s systems often have a wide
    range of screw choices, such as
    Monoaxial Screws, Polyaxial
    Screws, Reduction Screws, etc.
    MOSS MIAMI & ISOLA

    MOSS MIAMI ISOLA


    ANTERIOR SPINAL INSTRUMENTATION

    Allen Dwyer
    Zielke
    Kaneda
    Kostuik
    Z plate
    Etc.
    ALLEN DWYER - 1964
     Dwyer insert a specially
    designed screw and staple unit
    into each vertebral body at the
    apex of spinal curvature.
     A flexible, braided titanium-wire
    cable then was passed through
    holes in the heads of the
    screws.
     The compression was held by
    crimping the screw heads into
    the cable.
    KLAUS ZIELKE - 1975
     The Zielke system, developed in 1975, was the next step in the
    development of ventral instrumentation.
     The Zielke device connected transvertebral screws with a threaded rod
    and nuts and was more rigid than the Dwyer cables.
     This added both strength and the capacity for incremental correction
    and derotation, permitting a more powerful correction.
     The Zielke system produced a lower pseudarthrosis rate and
    somewhat lower recurrence of the flat back syndrome.
     In spite of these benefits, the system had many shortcomings. The
    pseudarthrosis rate remained high when the system was used as a
    stand-alone device but was lowered with supplementation of dorsal
    fixation.
     This system also suffered from the tendency to shorten the ventral
    columns and to produce kyphosis.
    ZIELKE SYSTEM + HARRINGTON
    POSTERIOR ROD
    KANEDA ANTERIOR SPINAL SYSTEM
     Initiated and developed by
    Kiyoshi Kaneda from Hokkaido
    University, Sapporo, Japan.
     It was frist used for anterior
    stabilization after anterior
    decompression in
    thoracolumbar burst fractures
    with neurologic deficits
     Consisted two pieces of
    vertebral plates with
    tetraspikes, two rigid rods, four
    screws, and eight nuts.
    THORACOLUMBAR SPINE INSTRUMENTATION

    Z-plate (Danek) Kaneda (AcroMed)


    SPINAL SURGERY & INSTRUMENTATION IN
    INDONESIA

    SOELARTO REKSOPRODJO SUBROTO SAPARDAN


    PEDICLE SCREW – SUBLAMINAR WIRE
    (PSSW)
    SUBROTO SAPARDAN
    UI SYSTEM 1998 – SUBROTO SAPARDAN
    SPINAL INSTRUMENTATION TO THIS DATE

    Non-Fusion Technique :
    Growing Rods

    Posterior Lumbar
    Interbody Fusion
    MOTION-PRESERVATION TECNIQUE
    TDR & DPS

    Motion preserving : Non-Fusion Stabilization Device :


    Disc arthroplasty Dynamic Posterior Stabilization
    SUMMARY
     Treatment of spinal deformity has improved due the development of
    advanced surgical techniques and improved spinal instrumentation.
     These advances allow surgeons to help their patients maximize their
    quality of life while striving to minimize the potential for complications.
     Advances in the past few decades have improved correction of spinal
    deformity, decreased the morbidity of surgical procedures, and allowed
    for earlier return to activity after surgery.
     Current research focuses on improving and developing motion
    preserving surgical techniques and less invasive surgical options.

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