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DYNAMIC STABILIZATION ANOTHER ALTER ATIVE TO fusion for select patients is dynamic stabilization. Younger patients who have low back pain caused by degenerative disc disease are ideal candidates for the procedure. Using screws affixed to vertebrae, surgeons use nonrigid devices to stabilize the affected area of the spine. "This is a way we can stabilize patients without fusing their spine," notes Zachariah M. George, MD, partner and neurosurgeon at Neurological Surgery, P.C. "The procedure helps them maintain some level of spinal mobility, which is important to people — especially younger patients." resolve. T he process includes t he following benchmarks: + Leg pain caused by pressure on the nerve can be alleviated one day after surgery. + Patients are out of bed and encouraged to walk the day after surgery. + Ten days after admission, many patients are discharged. + The rehabilitation process can last up to three weeks after surgery. + Patients can be weaned off any narcotic pain medication after two to three weeks. + Within six weeks, patients are often free of postoperative pain. "Recent studies show that patients older than 65 with degenerative scolio- sis have comparable functionality scores to patients with bilateral leg amputa- tions," Dr. Vaynman notes. "You can only imagine how dysfunctional these patients are and how much care they require. Even though spine conditions don't carry high mortality rates, my feel- ing is that people with these conditions don't enjoy life as much as they could. They also require a lot of care — some need 24/7 supervision and assistance, a nd that's difficult to provide. But with a good surgical plan and early referral — before they're weakened by the condition — we can significantly improve these patients' lives." Pressure Relief While an excellent option for scoliosis correction, fusion limits mobility and isn't ideal for all cervical spine conditions. The cervical vertebrae form the most vulner- able part of the spine. Exposing them to traumatic injury in addition to degenerative conditions — such as cervical spondylotic myelopathy, a condition in which a herni- ated disc and/or ligamenta flava hypertrophy (ligament overgrowth) puts pressure on the spinal cord — can result in the loss of function of the arms and legs and, in some cases, the bowels and bladder. "Cer vical spondylotic myelopathy is a progressive disorder that patients ca n sometimes tolerate for yea rs," Dr. Vaynman explains. "After accom- modating it for a while, patients can lose the ability to walk, hold things and coordinate function. As this happens, they begin to fall, and with each fall, the condition progresses more rapidly because the spinal cord bruises when it hits the area of compression." N S P C s u r g e o n s u s e d i f f e r e n t operative approaches, including fusion, discectomy and cervical laminectomy, depending on the levels of compression. Younger, hea lthier patients w ith one or two levels of compression can be treated with anterior discectomy, decompressing the nerve root and fusing the vertebral levels. Older patients who are in poor health and have more than three levels of compression can be treated by pos- teriorly removing the vertebrae and alleviating the pressure on the spinal cord. Surgeons use screws and rods to hold the spine in place. For the right patients, cervical lami- noplasty is an alternative procedure that obviates the need for fusion. "Not everyone who has spinal com- pression needs fusion," Dr. George says. "The capability to perform cer vical laminoplasty is important because it maintains cer vica l mobility lost in fusion procedures." Dr. George reviews treatment options with a patient.