Objectives

To assess the effectiveness of a modified tibial tubercle osteotomy as a treatment for arthroscopically diagnosed chondromalacia patellae.

Objective: To present early results of a new technique of dynamic stabilisation of the lumbo-sacral spine.

Design: Prospective study

Subjects: Between September 2000 and December 2001, 43 patients underwent posterior spinal stabilisation using the Dynamic Neutralisation System (DYNESYS) (Sulzer Medica).

Outcome Measures: Oswestry Disability indices, complications, visual analogue pain scores, patient satisfaction.

Results: The perceived indications were isolated degenerative disc disease (26), spondylolisthesis (8), degenerate adult scoliosis (4), failed Graf stabilisation (1), lumbar canal stenosis (3) and traumatic compression fracture (1).

Fixation was at one level in 14, two levels in 23, and three or four levels in 6 patients. Thirty-seven had Dyne-sys fixation alone and six had additional procedures at the same operation.

Complications included facet fracture (1), broken pedicle screw (1), apparent screw loosening (1) and discitis (1). At average follow-up of eight months (range 2–14 months), the average Oswestry disability score had fallen from 52 to 32 and the visual analogue pain score from 7.5 to 1.7. 65% of patients were pleased or better with their result.

Conclusions: The Dynesys system seems to be a safe alternative to conventional operative treatment for degenerative disorders of the lumbar spine without the need for rigid fusion. The anatomic re-stabilisation may allow the spinal segment to recover. The early results are encouraging. It is hoped that longer term follow-up will clarify the groups of patients who will benefit most from this procedure.