Motion Preservation Surgery

What is Motion Preservation Surgery?

Motion preservation surgery or Motion Preservation Spine Surgery (MPSS) is a relatively new surgical method employed as an alternative to standard spinal surgeries, such as spinal fusion surgery and disc replacement surgery in select patients to treat spinal conditions of the cervical and lumbar area and restore normal motion of the spine.

Spinal stenosis is one of the disorders that cause severe spinal pain. The common treatment employed for spinal stenosis is conventional spinal fusion surgery. This involves the fusion of 2 vertebrae permanently. Although the fusion surgery is effective in relieving pain, it ends up restricting normal motion of the spine and may also increase the risk of developing adjacent-level degenerative disc disease, which may warrant additional surgery. Motion preservation surgery serves as an effective alternative to spinal fusion surgery as it not only alleviates pain and restores normal motion of the joints, but also overcomes limitations associated with traditional spinal fusion.

Motion preservation spine surgery refers to a variety of newer surgical techniques that aim at preservation of the spine movement by replicating normal or near-normal biomechanics by utilizing a wide variety of motion preservation devices. These devices may include:

• Interspinous process spacers (such as the X-STOP) that open the foramen and central canal
• Posterior dynamic stabilization devices (such as cords, screws, rods, and/or spacers) that enable controlled or better motion of the spine
• Facet replacement or total part replacement devices that can replace the facet joints or all of the parts in the back of the spine with the aim of controlling or limiting motion.

Indications for Motion Preservation Surgery

Motion preservation spine surgery may be recommended as an alternative treatment for various spine disorders, including:

• Spinal stenosis
• Sciatic nerve pain
• Spondylosis
• Spondylolisthesis
• Pseudoarthrosis
• Nerve damage
• Scoliosis
• Kyphosis
• Degenerative disc disease
• Compression fractures in the spine

Preparation for Motion Preservation Surgery

Pre-procedure preparation for motion preservation spine surgery will involve the following steps:

• A thorough examination by your doctor is performed to check for any medical issues that need to be addressed prior to surgery.
• Depending on your medical history, social history, and age, you may need to undergo tests such as blood work and imaging to help detect any abnormalities that could threaten the safety of the procedure.
• You will be asked if you have allergies to medications, anesthesia, or latex.
• You should inform your doctor of any medications, vitamins, or supplements that you are taking.
• You should refrain from medications or supplements such as blood thinners, aspirin, or anti-inflammatory medicines for 1 to 2 weeks prior to surgery.
• You should refrain from alcohol or tobacco at least a week before and two weeks after surgery.
• You should not consume any solids or liquids at least 8 hours prior to surgery.
• Arrange for someone to drive you home as you will not be able to drive yourself after surgery.
• A written consent will be obtained from you after the pros and cons of the surgery have been explained in detail.

Procedure for Motion Preservation Surgery

Motion preservation spine surgery is performed in a hospital setting under local or general anesthesia. It is a minimally invasive surgery in which specially designed interspinous constructs are implanted in the spine. These constructs are polymer or metallic implants that are placed into the disc space and are secured to both sides of the vertebrae with fixation devices after removal of the disc or a portion of the disc. The constructs enhance the room between the vertebrae and relieve the pressure on nerves as well as aids in restoring the normal movement of the spine in all directions, including sideward, backward, and forward bending.

There are several types of interspinous devices that can be used during a motion preservation spine surgery based on the patient’s condition. Some of these include:

• Porous Coated Motion (PCM): This implant is used to treat patients with cervical radiculopathy in which nerve roots become pinched in the cervical area preventing normal function. The PCM system is comprised of 2 end plates with a polyethylene spacer. The end plates are attached to adjacent vertebrae and the spacer in between these plates. The interface between the 2 plate functions as a ball and socket motion enabling the patient to bend sideward, backward, forward, and to rotate freely.
• Coflex: This is a U-shaped implant with 2 wings on each side. The U-portion of the implant is positioned between the spinous processes and the wings are utilized to secure the adjacent spinous processes. This implant is employed to treat spinal stenosis in the lumbar region, and enables controlled backward and forward bending.
• Wallis: The Wallis implant is utilized to treat spinal stenosis and mild to moderate degenerative disc disease. This implant consists of a bio-compatible spacer made from elastic polymer and 2 elastic bands. The spacer is positioned between the damaged spinous processes and the bands are utilized to attach the spacer in place.
• X-STOP: This device is comprised of 2 titanium parts. One part is placed under and next to the spinous process and the other part is placed opposite the spinous process and later fastened to the first part. X-STOP has been shown to deliver considerable pain relief.
• DIAM (Device for Intervertebral Assisted Motion): This is an H-shaped implant spacer made from silicone and covered by polyester material. This spacer is positioned between the spinous processes which reinstate the height of the disc and is fastened with 2 ligatures that pass around the adjacent spinous processes and the spacer.
• Dynesys Spinal Stabilization System: This is a small implant comprised of tensioning cords, tubular spacers, and alloy pedicle screws made of polymer materials. It is placed on both the sides of the affected vertebra. It helps to stabilize the spine, enables the vertebra to keep its normal position, alleviates pain, and restores normal motion of the spine.

Postoperative Care and Recovery

In general, postoperative care instructions and recovery after motion preservation surgery may involve the following:

• You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs as you recover.
• Most patients may need to stay in the hospital for a day or two before discharge to home.
• You may experience pain, inflammation, and discomfort in the operated area. Pain and anti-inflammatory medications are provided as needed.
• You may be given cervical and lumbar assistive devices to wear for comfort and pain relief for a couple of weeks.
• Walking and moving around in bed is strongly encouraged to prevent the risk of blood clots.
• Keep the surgical site clean and dry. Instructions on surgical site care and bathing will be provided.
• Refrain from smoking and alcohol for a specific period of time as it can negatively affect the healing process.
• Refrain from strenuous activities and lifting anything heavier than 5 pounds until the first follow-up visit. These activities include housework, yard work, gardening, mowing, etc.
• Gentle neck and back stretches and regular walking is recommended to improve strength and endurance after the first follow-up visit.
• Refrain from driving until you are fully fit and receive your doctor’s consent.
• Most patients can return to their normal daily routines in 2 to 4 weeks after surgery.
• A periodic follow-up appointment will be scheduled to monitor your progress.

Benefits of Motion Preservation Surgery

Some of the benefits of motion preservation surgery include:

• Better spinal movement and flexibility
• Minimal surgical blood loss
• Minimal pain
• Faster recovery
• Short-term rehabilitation
• Reduced stress on the adjacent discs, minimizing the chances of a second surgery