BACK SURGERY

 

CASE PRESENTATION


 Preoperative X Rays in

HISTORY

 

 

 

The patient is a 32 years old woman who presented in clinic with 

  • severe back pain
  • bilateral leg pain worse on the left
  • Bilateral leg numbness
  • severely distressed
  • unable to walk or play with her kids

Imaging-MRI

  • L4-5 Disc protrusion (slipped disc)
  • Left L5 nerve compression
  • L4-5 Disc Degeneration-Modic type changes

Nonoperative Treatments

  • Physiotherapy
  • Medication (NSAIDs, Gabapentin/Pregabalin)
  • Nerve root Injections

Failed to improve symptoms

 

 

 

 

     

 

 

 

 

 Flexion and Extension Lateral Views

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Reveal kyphosis at the level of the affected disc


TLIF Surgery

Decision was made to proceed with lumbar fusion in order to allow

  • Improvement of back and leg pain
  • Restoration of the regional sagittal alignment

 

 Surgical planning 

Using electronic surgical planning software

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Global Alignment

&Proportion Score

 Preoperative Score in

Severe Disproportion 

Needs to be taken in account when planning

Surgical Technique

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Using a small aprox. 1 inch incision the pedicle is identified under X Ray guidance

  • A guidewire is placed in the pedicle

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  • A pedicle screw is placed and
  • The guidewire is removed

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Two pedicle screws are placed in each vertebra following the same steps

 

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Lateral intraoperative view to confirm satisfactory placement of all pedicle screw

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The disc is removed and autologus/synthetic bone graft is inserted in the anterior aspect of the disc before placement of the interbody cage

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Final Lateral  Intraoperative view

 

 

 

 Patient Reported Outcomes

(PROs)

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 2 years Follow-up X Rays

            AP                 Lateral

Preoperative to postoperative

GAP Score Improvement

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Patient Feedback

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 Preoperative to Postoperative X Rays

Advantages of

TLIF Surgery?

 

1.  Minimal Blood Loss

2.  Length of Stay 1-2 days

3.  Restoration of Sagittal Alignment 

4.  Long-term improvement of Pain 

5.  Improvement of Quality of Life


 

 

 

 


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