Advances in Spinal Instrumentation

Abstract

The use of spinal instrumentation has increased tremendously In the last ten years. Despite this explosion in technology, the goal of operation for instability remains a solid bony fusion, and the ultimate impact of new types of instrumentation on fusion outcome remains to be seen. Future gains in surgical fusion rates may depend as much on biological advances as on improvements in instrumentation. Autogenous bone remains the graft material of choice, but much work is underway in improving the quality of banked bone and even providing bone substitutes. A number of growth factors and bone matrix components are being considered for local application to graft beds. Finally, proper patient selection is becoming easier as more factors which affect the success of fusion operations are being elucidated. Recent advances in cervical spine instrumentation Include novel methods of atlantoaxial arthrodesis such as screw fixation of the odontoid and the Cl-C2 facet joints. Plate and screw systems have found wide applicability in both the anterior and posterior cervical spine, from Tl to the occiput. In the thoracolumbar spine, the advent of pedicle screw fixation and universal instrumentation systems have made it much easier to address the difficult problems of deformity, instability, and neural compromise resulting from a wide range of etiologies including idiopathic scoliosis, metabolic and degenerative diseases, and trauma. Improved instrumentation offers the promise of better surgical fusion rates. However, basic surgical tenets such as careful patient selection and meticulous surgical technique must be adhered to if successful outcomes are to be obtained.