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UC Davis Health System

UC Davis Health System

Dynamic stabilization provides alternative to fusion surgery for back patients

Photo of patient Phyliss Eres playing golf
Spinal surgery patient Phyllis Eres is back on the golf course after an innovative spinal surgery.

Phyllis Eres is passionate about golf. She plays a few times each week and, at recent golf tournaments in Northern California and Oregon, she finished first and second in her classification.

But before undergoing surgery earlier this year, Eres had endured back pain for so many years that she thought she might never play her beloved sport again.

Her back trouble stemmed from a bad fall in 1998. Eres, a legal assistant at the time, was walking to a courthouse in downtown Sacramento on a rainy day. She was carrying two box briefcases and her purse when she slipped on a sidewalk littered with pebbles.

“I kind of did the splits,” she says. “My left leg was behind me and I fell on it. It was a really bad fall.”

Misaligned spine

An MRI revealed that Eres' lumbar discs were damaged at multiple levels and, at lumbar levels 3 to 4, she had a misaligned spine with narrowing of the spine canal. A steroid injection gave her some relief for about six months, but the pain returned. Over the months, with each subsequent steroid injection, the period of relief gradually diminished until, after her last one, she could not walk out of the pain clinic.

After a final, ineffective steroid injection, Eres was referred to Kee Kim, chief of spinal neurosurgery, associate professor of neurosurgery, and co-director of the UC Davis Health System Spine Center. When Eres, who is 64, told Kim of her desire to continue playing golf, he suggested she undergo a surgical procedure recently approved by the U.S. Food and Drug Administration and used in Europe for more than five years.

Dynamic stabilization

The procedure is called dynamic stabilization. It involves the insertion of a flexible rod into the spine, instead of a traditional, rigid model. A device consisting of external spacers is attached to either side of the affected vertebra. The device stabilizes the joints, helping to keep the vertebrae in a more natural position while leaving the spine itself intact. Made of flexible materials, the device permits a controlled range of bending, straightening and twisting movement in the affected joints.

Kim says the procedure may give some patients a surgical option that allows them to maintain some flexibility and function while reducing pain.

Spine surgery more commonly focuses on reducing motion and flexibility to eliminate pain. For example, lumbar fusion surgery, a common procedure for low back pain or degenerative disease, fuses adjacent spinal discs together to reduce back pain, but it also reduces the flexibility and motion of the spine. Because it transfers additional stress to joints above and below the fused levels, fusion surgery may lead to accelerated degeneration.

Spinal stenosis treatment

Photo of x-ray with implanted device

Dynamic stabilization may be appropriate for patients with spinal stenosis and spondylolisthesis, or for a very select group with painful disc degeneration. In spinal stenosis, compressed nerves cause pain, numbness and tingling in the legs. Spondylolisthesis, commonly known as a slipped disc, is a condition where excessive or abnormal movement of the vertebrae causes pain in the low back or legs. The most common surgical treatment is to fuse the misaligned levels.

Because Eres had spinal stenosis and a misaligned spine, and wanted to maintain an active lifestyle, she was an ideal candidate for dynamic stabilization, Kim says.

“She's among the growing population of 'baby boomers' who still want to be very active and do the things they enjoy,” Kim says. “In her case, the procedure turned out to be a very good choice.”

Kim anticipates using dynamic stabilization increasingly on select patients to relieve their pain. “It won't totally replace fusion surgery, but there definitely is a certain number of patients who will benefit from this new procedure,” he says.

Eres, who had the surgery in January, resumed playing golf after a few months. “When I woke up in my room after surgery, I felt absolutely no pain,” she says. “It was just amazing to me. I didn't know how to act.”

Playing golf again

Before her injury, Eres was a 14-handicap golfer and traveled regularly with a group on golf outings. In mid-April, after a few follow-up visits with Kim, Eres was back swinging her clubs regularly.

“The surgery has given me my life back,” Eres says. “I would recommend this operation to anyone with sciatic problems. I give all the credit to Dr. Kim for finding the right solution for me.”

Grateful patients such as Eres “give me the greatest satisfaction in my job,” Kim says. “Pain can be so severe and dominate every aspect of someone's life. When I can minimize or relieve that, I can give people a new lease on life. It's very rewarding for me as a physician.”