Dynamic Interlaminar Stabilazation Removes Pressure from Discs

Background

Coflex® Interlaminar Stabilization

What is coflex® interlaminar stabilization?

Coflex® Interlaminar Stabilization is a surgical procedure that removes pressure from damaged joints and discs, while preserving the stability of the spine. It is an alternative to spinal fusion.

 When damaged sections of the spine are removed due to disease or damage, the stability of the spine is compromised. If the bones of the spine are fused to increase the structure’s stability, the spine can no longer bend at the point where the vertebrae were fused. Coflex® interlaminar stabilization provides stability for the spine, without making it rigid. The idea behind the Coflex® procedure was originally produced in Switzerland and further developed in Germany. Procedures similar to Coflex® interlaminar stabilization have been used on patients for approximately the past 15 years.

Treatments, Dynamic Interlaminar Stabilization of the Lumbar Spine2-1

What patients benefit from coflex® interlaminar stabilization?

The coflex® procedure is typically recommend for patients who have spinal conditions and disorders that result in spinal instability and who have been unsuccessful in treating their condition with conservative or non-surgical methods.

  • Young people. Young individuals who have injured their back and don’t want to be limited by immobility of part of the spine.
  • Elderly patients. In older individuals, spinal fusion is not always successful. This is due to the effects of aging on the spine and on healing. Fusion may not occur, and coflex® interlaminar stabilization is more likely to be helpful.
  • Herniated disc patients. Rarely, coflex® interlaminar stabilization is used after a section of a herniated intervertebral disc has been removed and another portion bulges. Future problems can be prevented by insertion of the coflex® device following removal of the removal of the herniation.
  • Spinal stenosis. Many conditions can lead to spinal stenosis, or abnormal narrowing of the spinal canal. When the passageway for the spinal cord and nerve roots is too small, nerve or spinal cord compression can occur, causing severe pain and other symptoms and possible complications. Coflex® interlaminar stabilization can be used to alter the position of the vertebrae and discs, creating more room in the spinal canal. This takes pressure off the spinal cord and its nerves and the coflex® device provides added stability to the spine.

What to expect before coflex® interlaminar stabilization surgery

No two patients are exactly alike and if you are scheduled for coflex® interlaminar stabilization surgery, your surgeon will provide you with pre-op instructions. Be sure to follow your surgeon’s instructions exactly as directed. The procedure will be explained to you and you will be given the opportunity to ask questions. If you have any concerns or questions about the surgery, be sure to ask. Following is a list of instructions you may find helpful related to spinal procedures, including the coflex® interlaminar stabilization operation.

  • Make sure your bowels are regular. Constipation following surgery is a problem you don’t need, so make sure your bowels are working well before your coflex® interlaminar stabilization procedure. Two days before your operation, take a stool softener or gentle laxative, like senna or colace. Make sure you are eating well and drinking plenty of fluids. This will help ensure you are well hydrated and on a regular bowel schedule prior to surgery.
  • Nothing to eat. On the day of your coflex® interlaminar stabilization surgery you will not be able to eat or drink anything by mouth. Your doctor and nurses may refer to this as NPO (nothing by mouth). Don’t have anything to eat after bedtime the night before your procedure. Most doctors don’t allow you to have anything to drink after midnight, but you may be able to take your morning medications with a small sip of water.  
  • Communicate with your surgeon. Before coflex® interlaminar stabilization  surgery, your surgeon needs to know the name of every medication you are taking and how much of each medication you take. This includes prescription and non-prescription drugs, as well as supplements and herbs. Your surgeon also needs to know if you are allergic to any medications, foods, or any other substances, and if you or any family members have ever had a reaction to anesthesia. If you are taking blood thinning medications, aspirin, or nonsteroidal anti-inflammatory drugs, these will need to be stopped several days before your coflex® interlaminar stabilization to reduce the chance of excessive bleeding.
  • Shower. Both the night before and the morning of surgery, patients scheduled for coflex® interlaminar stabilization are asked to shower using an antibacterial soap. Even though the surgical site is cleaned well prior to an incision being made, showering before surgery helps reduce the risk of infection due to contamination of the skin.

What will happen during coflex® interlaminar stabilization?

Most often, patients are given fluids and medications through an intravenous (IV) line in their arm or hand. Initially, the medications will help you relax and once in the operating room, general anesthesia will be given through the IV line to put you completely to sleep. While asleep, the anesthesiologist will insert a breathing tube to help you breathe while you are asleep.

You will lie on your abdomen throughout coflex® interlaminar stabilization surgery. Your back will be cleaned thoroughly and then any part not being operated on will be covered with sterile cloths. There are two different approaches the surgeon can use for coflex® interlaminar stabilization. These are called the midline approach and the Tramline (Wiltse) approach.

  • The midline approach to coflex® interlaminar stabilization: Only one small incision is made in this procedure after placement has been confirmed by X-ray. A microscope and small surgical instruments are used to remove pressure from the spinal column and the coflex® interlaminar stabilization device is inserted. The normal structures of the spine are not distorted in this approach due to highly controlled circumstances. Following insertion of the coflex® device, the incision is closed.

Following coflex® interlaminar stabilization surgery

From the operating room, most patients move to the recovery room or PACU (Post-Anesthesia Care Unit) where they are monitored by nurses to ensure their condition is stable. Some patients are discharged from the hospital on the same day, while others remain in the hospital for a day or so. This depends on the reason for the coflex® interlaminar stabilization procedure, the patient’s overall condition and on the surgeon’s orders.

When patients are fully awake, they are usually allowed to drink, starting with clear liquids, and then advancing back to their normal diets as tolerated. To help prevent nausea and vomiting, try not to drink and eat too much or too quickly right after your coflex® procedure.

The nurses will take care of any incisional care or wound dressings while you are in the hospital. You will be instructed how to take care of your incision before you go home.

Rehab following a coflex® procedure

Rehabilitation after coflex® interlaminar stabilization surgery usually involves physical therapy. Nurses will help you get out of bed soon after your procedure and physical therapists will soon have you walking short distances. Lightheadedness and dizziness are commonly reported after surgery. These will resolve as your strength returns. You may be fitted for a brace to wear to help support your spine. Physical therapists sometimes help with braces after coflex® interlaminar stabilization. Be sure to follow your surgeon’s instruction regarding when and for how long to wear your brace. 

What is the expected outcome of coflex® interlaminar stabilization surgery?

Most patients experience significant improvements in their symptoms following coflex® interlaminar stabilization.

It may take several weeks to recover from the procedure. Patients typically return to their surgeon approximately six weeks after surgery for follow up and X-rays. If the X-rays show healing and the coflex® device is in the correct position, many patients return to physical therapy to work on muscle strengthening and flexibility exercises and techniques to improve their posture.

Because the coflex® interlaminar stabilization procedure is relatively new, long-term outcomes are not yet known. Testing of the device was extensive and the outcome of clinical trials has been positive. Studies are on-going to monitor the value of coflex® interlaminar stabilization and further results will become available in the future.