BACK SURGERY
CASE PRESENTATION
Preoperative X Rays
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
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
Global Alignment
&Proportion Score
Preoperative Score
Severe Disproportion
Needs to be taken in account when planning
Surgical Technique
Using a small aprox. 1 inch incision the pedicle is identified under X Ray guidance
- A guidewire is placed in the pedicle
- A pedicle screw is placed and
- The guidewire is removed
Two pedicle screws are placed in each vertebra following the same steps
Lateral intraoperative view to confirm satisfactory placement of all pedicle screw
The disc is removed and autologus/synthetic bone graft is inserted in the anterior aspect of the disc before placement of the interbody cage
Final Lateral Intraoperative view
Patient Reported Outcomes
(PROs)
2 years Follow-up X Rays
AP Lateral
Preoperative to postoperative
GAP Score Improvement
Patient Feedback
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
DO YOU HAVE BACK PROBLEMS?
