In 1911, Hibbs and Albee first applied the posterior lumbar fusion technique to treat cases of spinal deformities, and more than 40 years later Smith and Robinson and Cloward proposed anterior cervical interbody decompression fusion for cervical spondylolisthesis.
After nearly a century of development and clinical practice, spinal fusion techniques have been widely used to treat various degenerative spine disorders. Spinal fusion techniques have been used to obtain excellent recent results by reconstructing intervertebral height and increasing segmental stability, and are now the conventional method for the treatment of degenerative spinal disorders and have become the gold standard for evaluating the effectiveness of treatment of such disorders. However, fusion fixation alters the normal biomechanical environment of the functional units of the spine, resulting in loss of motion of the corresponding spinal segment, leading to concentrated stress loads and increased abnormal activity in the adjacent segments, thus accelerating the degeneration of the adjacent segments. In recent decades, spine surgeons from all over the world have been thinking about the possibility of using methods that are close to the normal physiological environment of the spine to solve degenerative spine diseases, and the concept and methods of non-fusion dynamic fixation have emerged. In this paper, we review the main non-spinal fixation methods and techniques. This article provides a brief review of the major non-fusion techniques currently available for the spine. Vertebroplasty X was first introduced by Oyama, a Japanese physician, in 1973. This procedure indirectly relieves spinal cord compression by enlarging the spinal canal while preserving the posterior cervical structures and the mobility of the cervical spine. Many different modifications of this procedure have subsequently emerged, and there are two main types that are currently widely used: single-opening and double-opening. The common goal of laminoplasty X is to increase the area of the spinal canal by reconstructing the posterior bony arch while minimizing fusion of the decompressed segments and preserving the mobility of these segments of the cervical spine. Despite the varying degrees and duration of postoperative shoulder axis pain, the excellent spinal cord decompression and functional improvement of posterior longitudinal ligament ossification and long-segment spinal cord cervical spondylolisthesis with laminoplasty X has been well accepted by a wide range of physicians. Spinal canal enlargement and functional improvement with laminoplasty X are better in patients with anterior cervical convexity than in patients with posterior cervical convexity. Factors that affect the outcome of vertebroplasty X in addition to cervical spine sequence include: spinal cord atrophy, long duration of symptoms, old age, severe spinal cord compression and nerve root pathology. Since the advent of the cervical artificial disc replacement (ADR) technique at the end of the last century, it has quickly become accepted by the majority of spine surgeons and is now growing rapidly in number of cases due to its advanced concept and preservation of the physiological motion of the corresponding segment compared to the classical anterior cervical decompression fusion (ACDF). The overall understanding of the cervical ADR technique is that adequate decompression is a guarantee of the near-term efficacy of the procedure, and that the indications for performing cervical ADR must be strictly controlled, which directly affects the medium- and long-term outcome of the treatment. There is no significant difference in symptom relief, surgical complications, or patient satisfaction in the near- to mid-term outcomes of single-segment replacement compared with traditional ACDF surgery, but ADR has significant advantages over ACDF in preventing or slowing degeneration of adjacent vertebrae. The coexistence of multiple methods of treatment for multi-segmental disc degeneration cases, such as multi-segmental ADR, ADR combined with interbody fusion and ADR combined with minimally invasive techniques, requires further clinical study. The cervical artificial disc prosthesis is diversified, and there is no distinction between superior and inferior artificial discs, each with its own characteristics and different surgical techniques, and there is a certain learning curve when using them. In addition, reports on the complications and prevention of cervical artificial disc replacement have increased, which indicates that cervical artificial disc technology is becoming increasingly mature. Although the lumbar artificial disc technology was developed earlier (1980s) than the cervical spine, it has not been widely developed and promoted, mainly because of the high technical requirements of lumbar artificial disc replacement, long learning curve, many and serious complications, difficulty of revision, and the imperfections in the design of lumbar artificial disc prosthesis, which have limited the promotion of this technology. It is gratifying that the initial exploration of laparoscopic lumbar artificial disc technology has emerged in recent years and achieved good results, which points to the direction for the future development of lumbar artificial disc technology. In addition, the indications for lumbar artificial disc replacement should be strictly limited to discogenic low back pain, and lumbar artificial disc replacement should be performed with caution in cases where leg pain is the main cause. Lumbar artificial nucleus pulposus replacement technology, because the design of the prosthesis has not reached the ideal clinical requirements, early attempts to apply it have not been continued for a longer period of time due to many complications and the special medical environment in China, and it is on the verge of elimination, but there are advantages in the concept of artificial nucleus pulposus replacement, and it is believed that with the future improvement of the prosthesis design, it should have a place in the field of spinal non-fusion. The lumbar interspinous fixation (dynamic stabilization device) forms a “floating” device between the spinous processes, which can share part of the load of the intervertebral disc and the articular eminence joint by moderate support. The limited stretch of the upper and lower interspinous straps or other fixation devices limits excessive flexion and extension of the implanted segment, reduces interspinous and articular joint compressive stresses, and preserves a certain range of mobility of the corresponding segment. The Lumbar Interspinous Dynamic Stabilization System is being promoted more rapidly because of its advanced concept, lack of technical learning curve, and ease of revision. Domestic clinical applications are mainly focused on Wallis
After the accumulation of clinical experience in the past five years, we have our own experience and summary on the exploration of its indications and precautions in surgical techniques, but its long-term efficacy and grasp of indications still need the test of time, and it can be said that its future is bright, but there are still many aspects that need to be improved. Lumbar elastic arch system and semi-strong fixation technology, in recent years, the initial application of domestic reports, the early effect is good, but the lack of systematic research, more than ten years of follow-up and strong fixation reported abroad, the clinical effect is more satisfactory, to delay the degeneration of adjacent segments than the traditional strong fixation, but this aspect of the research report is still small, and traditional fixed fusion which is better or worse, it is too early to conclude There is still a long way to go. In conclusion, non-fusion technology in the spine brings new ideas and hope for the treatment of degenerative spinal diseases.