Dynamic stabilisation: cosmic system

Cosmic is a pedicle screw rod system for surgically stabilising therapy-resistant lumbagos and lumbar radiculopathies without performing a spinal fusion. After 2 years, the clinical results were found to be comparable to those achieved with spinal fusion. The complication rate including complications in relation to the implant is equivalent to the lower-to-middle third of the complications reported after spinal fusion. While using the cosmic system, attention to the contraindications is essential. No more than three segments may be stabilised and stabilisation must only be performed in situ, where slight distractions up to 4 mm in the segment are permissible. Stabilisation with cosmic, but without spinal fusion offers the following advantages: a reduction in surgical trauma, avoidance of pain via the bone-chip extraction site and preservation of the intervertebral cartilage; this means that the damping function of the intervertebral cartilage is retained. For low invasive implantation, a cosmic screw with a tulip head (cosmic mia) and special instruments are designed. Spontaneous fusions were not observed during the period of observation, but it is assumed that the stabilisation will cause fibrous rigidity over time. No reduction in the height of the intervertebral cartilages in the adjacent segment was found after 2 years. The question as to whether the risk of connection segment instabilities can be reduced with cosmic stabilisation in comparison to fusions can only be answered after a longer follow-up.