Dynamic Interspinous Assisted Motion (DIAM)

Compliance with NICE

A. Kasis, K. Lingulta

G. Reddy, T. Friesem

Spinal Unit, North Tees Hospital

Non-rigid stablization?

• Non rigid stabilization of the L spine

• Alternative to fusion

• Distraction

• Some motion

First review, July 2005

DIAM

• Conforms to interspinous anatomy

• Minimal distrubance to segmental muscles

• Two independent laces

Devices reviewed by NICE

• Bronsard and Graf ligaments

• Dynesys systems (Pedicle screws)

• Mims device

• DIAM

• Wallis

• X stop.

March 2006

Specialist advisors

Consultants nominated by their specialist society or by the Royal College

Literature review

• Christie SD, Song JK, Fessler RG. Dynamic interspinous process technology. Spine. 2005 Aug 15;30(16 Suppl):S73-8.

• Stoll TM, Dubois G, Schwarzenbach O. The dynamic neutralization system for the spine: a multi-center study of a novel non-fusion system. Eur Spine J. 2002 Oct;11 Suppl 2:S170-8. Epub 2002 Sep 10.

• Grob D, Benini A, Junge A, Mannion AF. Clinical experience with the Dynesys semirigid fixation system for the lumbar spine: surgical and patient-oriented outcome in 50 cases after an average of 2 years. Spine. 2005 Feb 1;30(3):324-31.

• Rigby MC, Selmon GP, Foy MA, Fogg AJ. Graf ligament stabilisation: mid- to long-term follow-up. Eur Spine J. 2001 Jun;10(3):234-6.

• Markwalder TM, Wenger M. Dynamic stabilization of lumbar motion segments by use of Graf's ligaments: results with an average follow-up of 7.4 years in 39 highly selected, consecutive patients. Acta Neurochir (Wien). 2003 Mar;145(3):209-14; discussion 214.

Recommendations

1. Inform clinical governance

2. Patients, written information

3. Audit and review

Spinal unit, North Tees

• 10 patients (13 prosthesis)

• Average age 59 (38-78)

• 6 female

Indications

• 6 spinal stenosis

• 3 spinal stenosis with facet arthropathy

• 1 patient with 2 levels disc degenerations, not suitable fusion/disc replacement (Jehovah Witness)

Pre-op investigations

• MRI

• Plain X rays

• 2 patients had discography

9 spinal rehab with no benefit

4 sacral epidural injection

One nerve root block

Pre-op treatment

• Most common level L4/5

• Most common size used 10 and 12

• Average length of surgery about 40 minutes per prosthesis

• Length of stay 1.3 days per prosthesis (1-3)

Advantages

• No blood transfusion required

• No neurological complications

• No infection

• No spinal canal intrusion

Compliance with NICE

All patients received NICE leaflet

Notes record:• 9/10 record of giving the leaflet.• 10/10 record of all possible complications• 10/10 record of success rate, and possible

requirement of additional procedure• 10/10 record of new procedure

Satisfaction

• 10/10 patients were satisfied with the procedure, at the first review in the clinic.

• Average follow up is 2.3 months (1.5-6)

Recommendations

• Re-audit at a longer follow up

• Another literature review

57 y old lorry driver (Jehovah Witness), with 2 level degenerative disease, 3 months post DIAM procedure, patient returned to work 4 weeks post

op.

Thank You