In the September 22, 1990 issue of the prestigious British medical journal The Lancet Mr. Sean Hughes of the Clinical Research Unit of the Princess Margaret Rose Orthopaedic Hospital inEdinburgh wrote the review of the textbook “The Lumbar Spine” published by members of the International Society for Study of the Lumbar Spine (Weinstein JN and Wiesel SW Editors, Saunders: Philadelphia). In his review Hughes pointed out that the chapter on spinal fusion- “Where It’s Been and Where It’s Going” was “thought provoking” and of “particular interest.” He felt that, as the last chapter in the book, it set “the scene for future editions.”
After a decade this “scene” has not yet been realized, but there is good evidence, at the beginning of the new millennium, that more and more enlightened clinicians are now beginning to grasp that more physiologic and dynamic means of stabilizing the human spine (especially the lumbar spine) are more in the patient’s best interest. The terms “Spine Arthroplasty” and “Reconstructive Spine Surgery” have been created by some to serve as a more integrated description for these modern technologies. The indiscriminate and sometimes inappropriate use of rigid instrumented fixation devices on patients with multi-level or genomic degenerative processes, particularly the multi-level pedicle screw implant systems continue, however, to thwart the principles of both Hippocrates as well as those of William of Occam.
Basic laboratory investigation regarding flexible spine stabilization and patents (in 1988 and 1994) continuing to the present have provided a scientific basis for more rational surgical approaches in treating spine disease with flexible stabilization systems.
An important step forward will occur when the spine care community finally recognizes that the term “fusion” has become outdated and confusing. Some examples of the “Wright brothers” stage of flexible instrumented stabilization have now appeared on the clinical scene. It is the opinion of the Burton Report staff that flexible stabilization devices are just now beginning the World War I biplane phase of development, with the World War II P-51 phase still on the “drawing board”.
In order to maintain an important perspective on the passing scene it must be pointed out that flexible stabilization represents only one facet of modern non-fusion technologies. The transition from “fusion” to restorative spine care will not be revolutionary, but evolutionary.