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Dynamic Interspinous Assisted Motion (DIAM) Compliance with NICE

Dynamic Interspinous Assisted Motion (DIAM) Compliance with NICE. 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.

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Dynamic Interspinous Assisted Motion (DIAM) Compliance with NICE

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  1. Dynamic Interspinous Assisted Motion (DIAM)Compliance with NICE Kasis, K. Lingulta G. Reddy, T. Friesem Spinal Unit, North Tees Hospital

  2. Non-rigid stablization? • Non rigid stabilization of the L spine • Alternative to fusion • Distraction • Some motion

  3. First review, July 2005

  4. DIAM • Conforms to interspinous anatomy • Minimal distrubance to segmental muscles • Two independent laces

  5. Devices reviewed by NICE • Bronsard and Graf ligaments • Dynesys systems (Pedicle screws) • Mims device • DIAM • Wallis • X stop.

  6. March 2006

  7. 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.

  8. Recommendations • Inform clinical governance • Patients, written information • Audit and review

  9. Spinal unit, North Tees • 10 patients (13 prosthesis) • Average age 59 (38-78) • 6 female

  10. Indications • 6 spinal stenosis • 3 spinal stenosis with facet arthropathy • 1 patient with 2 levels disc degenerations, not suitable fusion/disc replacement (Jehovah Witness)

  11. Pre-op investigations • MRI • Plain X rays • 2 patients had discography

  12. Pre-optreatment 9 spinal rehab with no benefit 4 sacral epidural injection One nerve root block

  13. 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)

  14. Advantages • No blood transfusion required • No neurological complications • No infection • No spinal canal intrusion

  15. 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

  16. 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)

  17. Recommendations Re-audit at a longer follow up Another literature review

  18. 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.

  19. Thank You

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