Unwarranted Complication in Posterior Dynamic Stabilization of the Spine: Review of Literature and Description of a Case Encountered by the Author

PLIF is a common procedure used to stabilize the spine. It is rigid and results in ASD (Adjacent segment degeneration). In recent times, posterior dynamic stabilization (PDS) has become popular. The implant is inserted either directly or by percutaneous method in the interspinous or the inter-laminar space. It is then fixed to the spinous processes. Superion and CoFlex are FDA approved and popular devices in the market. During the operative procedure, at times one of the spinous processes breaks leaving the surgeons perplex about how to proceed. In our experience with 300 CoFlex PDS, we encountered one case where one of the spinous processes (L4) broke. The senior author is familiar with intra-spinous process drilling. This technique was utilized to thread through the drill holes a Vicryl, and tie the two broken pieces of spinous process together successfully. The surgical procedure was concluded by the insertion of the CoFlex PDS. In the literature, we found a few articles mentioning on the breakage. In all these cases, the procedure was abandoned. Two years have passed and the patient continues to remain symptom free without any displacement of the implant.