Motion-Preserving Stabilisation
Motion-preserving stabilisation refers to a class of advanced surgical procedures designed to stabilise unstable spinal segments or treat stenosis while retaining segment motion, avoiding the need for a rigid spinal fusion. By using dynamic stabilisation systems (such as interspinous implants or flexible posterior rod systems), the surgeon can limit abnormal movement, offload the facet joints, and maintain spinal alignment, while preserving natural biomechanics and reducing adjacent segment degeneration.
When this procedure may be recommended
- Moderate to severe spinal stenosis that worsens when standing or walking, which is relieved by sitting or bending forward (neurogenic claudication).
- Mild dynamic spondylolisthesis (Grade 1) with preserved disc height and facet joint integrity.
- Recurrent disc herniation where further decompression might destabilise the spinal segment.
- Adjacent segment disease where a prior fusion has placed excessive stress on the neighbouring vertebrae.
Who may be a candidate
Ideal candidates are patients with neurogenic claudication or mild segment instability who have failed conservative care but retain mobile, relatively healthy disc spaces and facet joints. Patients with severe spinal deformity, high-grade spondylolisthesis, significant osteoporosis, or active spinal infection are not suitable for motion-preserving implants.
Advanced medical implant technology (no text). Alternatives to surgery
- Conservative management, including core-strengthening physical therapy, anti-inflammatory medications, and epidural injections.
- Standard spinal decompression (laminectomy) alone without stabilisation.
- Standard spinal decompression with rigid instrumented spinal fusion.
What to expect
- Anaesthesia: The procedure is performed under general anaesthesia with the patient in a prone (face down) position.
- Access: A small midline incision is made in the back over the affected spinal segment, using muscle-sparing techniques.
- Decompression: A targeted decompression (such as a partial laminectomy or laminotomy) is performed to relieve pressure on the compressed nerves.
- Implant Insertion: The dynamic stabilisation device (such as an interspinous spacer, e.g., coflex, or dynamic pedicle screw system) is carefully inserted between the spinous processes or secured to the pedicles under fluoroscopic guidance.
- Securing: The implant is secured into place, ensuring it limits extension (which narrows the spinal canal) while allowing flexion and rotation.
- Closure: The surgical field is irrigated, and the muscle, fascial, and skin layers are closed in layers.
Technology and imaging
Employs advanced biocompatible interspinous titanium spacers, dynamic pedicle-based systems, and real-time fluoroscopic guidance for precise implant placement.
High-precision diagnostic imaging visualization. 
Clinical Zeiss/Leica operating microscope setup. Hospital stay
Typically 1 to 2 nights in hospital, with many patients ready for discharge on the day following surgery.
Recovery milestones
- Immediate: Patients are encouraged to stand and walk within hours of surgery. Pain is often significantly less than after a traditional fusion.
- Weeks 1-4: Gradual increase in walking and light daily activities. Avoid heavy lifting and extreme spinal flexion or extension.
- Weeks 6+: Initiation of structured physical therapy to focus on posture, stability, and abdominal/core strength.
- Months 3+: Gradual return to full recreational activities, including low-impact sports, with preserved spinal flexibility.
Post-operative mobilization and recovery milestones. Risks and complications
- Implant dislodgement or migration (extremely rare with correct sizing, under 1% to 2%).
- Spinous process fracture during or after implantation, particularly in patients with undiagnosed osteoporosis.
- Nerve root injury, temporary numbness, or persistent leg pain.
- Persistent or recurrent stenosis symptoms requiring conversion to a formal spinal fusion.
Frequently asked questions
How does motion-preserving stabilisation differ from a spinal fusion?
A spinal fusion permanently joins two or more vertebrae together, eliminating all motion at that segment, which can increase stress on adjacent segments. Motion-preserving stabilisation uses flexible or dynamic implants to support the segment and prevent abnormal painful motion, while retaining a natural range of movement and protecting neighbouring discs.
Can an interspinous spacer be removed if needed?
Yes. One of the advantages of interspinous spacers and dynamic stabilisation is that the procedure is largely reversible. If a patient does not get sufficient relief or if their spinal condition progresses, the implant can be safely removed and converted to a formal decompression and fusion surgery.