title: [Dynamic posterior stabilization with the cosmic system].
abstract: OBJECTIVE
  Stabilization of unstable motion segments with a stable but non-rigid implant system without an additional spondylodesis.
  
  
  METHODS
  Neurogenic claudication with instability; discogenic pain; in combination with a fusion (hybrid technique); elongation of a preexisting fusion; second recurrence of a herniated disk.
  
  
  METHODS
  Increased instability; correction and reduction; instrumentation of more than three levels.
  
  
  METHODS
  Muscle-sparing approach to the posterior lumbar spine under anteroposterior and lateral image control. Use of special instruments with a slotted sleeve connected to the screw head for rod implantation. Alternatively: conventional midline approach with detachment of muscles from the posterior spine.
  
  
  METHODS
  Mobilization on the day after surgery. Limited physical activities and no work load for 6 weeks.
  
  
  RESULTS
  In 139 patients (77 females, 62 males, average age 55 years) with a follow-up of 2 years, Oswestry score improved from 49.0% preoperatively to 22.5% and VAS (visual analog scale) from 7.3 preoperatively to 2.5 after 2 years. No change of the lordosis. Eleven revisions (7.9%). Two broken screws (0.3%) and 17 screws (2.5%) with a radiolucent halo.
authors.affiliation: Orthopädische Abteilung, Landeskrankenhaus Feldkirch, Feldkirch, Österreich. orthopaedie@lkhf.at
authors.forename: Archibald
authors.initials: A
authors.lastname: von Strempel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001178:Arthroplasty / Q000295:instrumentation*; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000601:surgery*; D007593:Joint Instability / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019736:Prostheses and Implants; D011474:Prosthesis Design; D019919:Prosthesis Implantation / Q000379:methods*; D013122:Spinal Diseases / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome; D021801:Zygapophyseal Joint / Q000601:surgery*