Case Examples

Spinal Surgeon in Liverpool & Wirral 

 

 NECK SURGERY


  ACDF

  Posterior Cervical Fusion  

 

 

 

      DEFORMITY


Degenerative Spondylolisthesis  

Isthmic Spondylolisthesis  

Scheuermann`s Kyphosis Correction      

Complex Adult Deformity Correction

  • Degenerative Scoliosis
  • Adult Idiopathic Scoliosis
  • Coronal&Sagittal Plane Deformity

    BACK SURGERY


       1:  Microdiscectomy

       2:  Laminectomy/Decompression

       3:  Open TLIF  

       4:  MIS TLIF 

 

 

 

 

 

CASE PRESENTATION Isthmic Type Spondylolisthesis


Spondylolysis-Isthmic Spondylolisthesis

History Summary

  • 23 year old man
  • Professional Footballer
  • Had to quit playing because of Severe Right-Sided Lower Back Pain
  • Extensive Physiotherapy - No help
  • Pain management failed

The patient was a 23 year old professional footballer who was forced to quit playing because of severe right sided lower back pain. Extensive physiotherapy and Pars injections had failed to improve his pain.

Lumbar spine X-rays revealed that the patient was suffering from Grade I Isthmic Type Spondylolisthesis. After failure of nonoperative treatments the patient underwent an MIS Transforaminal Interbody Fusion (MIS TLIF). Immediately after surgery his pain has resolved. 

Six months after the operation following extensive post-operative rehabilitation he returned to playing football.

 
DETAILS   

 
 

Diagnosis - Lumbar Spine X Rays

  • Grade I Isthmic Type Spondylolisthesis
  • Read more: http://www.britscoliosissoc.org.uk/patient-information/spondylolysis

Spino-Pelvic Alignment

Consultant Spinal Surgeon  in Liverpool and Wirral

 

Consultant Spinal Surgeon  in Liverpool and Wirral

Consultant Spinal Surgeon  in Liverpool and Wirral

 

Flexion & Extension Lumbar X Rays

Consultant Spinal Surgeon in Liverpool and Wirral

MRI-No nerve compression

Consultant Spinal Surgeon in Liverpool and Wirral

Consultant Spinal Surgeon  in Liverpool and Wirral

 

 

 

CT scan-Bilateral L4 Pars Fractures

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TREATMENT OPTIONS

Non-surgical

  • Pars Injections-Had very short term relief
  • Physiotherapy post-injection -No help

Surgical

  • Bilateral Pars screw fixation?

- Not indicated because of the instability

  • MIS Transforaminal Interbody Fusion (MIS TLIF)

- Decided to proceed with this option

- Discussed possibility to return playing after extensive post-operative rehabilitation

 

 

Intraoperative Fluoroscopic Images

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6 Months Post-operative Follow-up

  • Patient asymptomatic
  • No back/leg pain
  • Starting running/cycling
  • Lost significant weight gained in the last few months
  • Training with personal trainer

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Self Reported Clinical Outcomes

Consultant Spinal Surgeon  in Liverpool and Wirral

 

HIDE DETAILS   

 

 

CASE PRESENTATION Scheuermann`s Kyphosis Correction


Scheuermann`s Kyphosis in Adult Patient

History Summary

  • 26 years old man
  • Complains of back pain
  • Cosmetic concerns-prominent back
  • Tried pain medication
  • Physiotherapy

The patient was a 26 year-old man who experienced back pain and had serious cosmetic concerns as to a prominent curve in the back. The patient had tried various pain medication and physiotherapy but these had not helped to alleviate the pain.

The patient underwent analysis of the deformity using electronic surgical planning software. The cause of the deformity was attributed to an increased Thoracic Kyphosis (Scheuermann`s disease).

Surgery consisted of posterior spinal fusion which resulted in correction of the kyphotic deformity. The Lumbar Lordosis decreased from 83 to 52 degrees, whilst the Thoracic Kyphosis decreased from 82 to 45 degrees. Normal alignment was attained. The cosmetic result was also very satisfactory for the patient.

 
DETAILS   
 

 

Diagnosis - Scheuermann`s Kyphosis

  • Read more about this condition: http://www.britscoliosissoc.org.uk/patient-information/kyphosis

Consultant Spinal Surgeon  in Liverpool and Wirral

Consultant Spinal Surgeon  in Liverpool and Wirral

 

 

Analysis of The Deformity Using Electronic Surgical Planning Software

  • Increased Thoracic Kyphosis: Primary cause of Deformity
  • Compensatory Hyper-lordosis

Surgical Planning

  • Removal of Compensatory Lordosis reveals magnitude of deformity

 

 

 

 

Global Sagittal Alignment Goals

Osteotomies Plan

 

 

Osteotomies Plan Continued...

 

 

 

 FINAL RESULT

Before Surgery

Consultant Spinal Surgeon  in Liverpool and Wirral

After Surgery

 Corrections

  • Correction of Primary Deformity: Thoracic Kyphosis decreased from 82 to 45 degrees
  • Reversal of Compensatory Hyper-lordosis: Decrease of Lumbar Lordosis from 83 to 52 degrees

 

Result: Normal Age Adjusted Alignment Achieved 

BEFORE

AFTER

HIDE DETAILS    

 

CASE PRESENTATION Cervical Disc Herniation


 

History Summary

  • 63 years old man
  • Chronic Neck Pain
  • Left Arm pain, Weakness, Dysesthesia
  • Unable to sleep

Exam

  • Left Triceps weakness 4/5
  • Left C6&C7 dermatomal distribution decreased sensation

 X Rays

 

 

 

 

 

 

 

 

 

 Diagnosis- Cervical MRI

  • C5-6 and C6-7 Disc Protrusions
  • Impingement of the Left C6 abd C7 nerves
  • Left C6 and C7 CT guided nerve root injections failed significantly helped for 6 weeks but then symptoms returned to the pre-injection level

MRI: Sagittal View

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C5-6 Axial view

Left C6 nerve impingement

 

 

 

 

 

 

 

 C6-7 Axial view

Left C7 nerve impingement

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     Treatment C5-6 and C6-7 ACDF

Intraoperative Fluoroscopy Views

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 2 YEAR Follow-Up X Rays

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CASE PRESENTATION: Cervical Spondylotic Myelopathy (CSM)


Multilevel ACDF

 

History Summary

  • 48 years old businessman
  • Very active  traveling very often
  • Likes playing football

 Presentation

  • Severe Gait&Balance problems
  • Neck pain
  • Bilateral Arm Dysesthesia
  • Started having Falls
  • Dexterity problems

 

 

 

          Lateral Cervical X Ray       CT scan-sagittal view 

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MRI Cervical Spine

                                     Sagittal View                          Axial Views C4-7

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Diagnosis

Cervical Spondylotic Myelopathy C4-7

 

Exam:

  • Left Triceps weakness
  • Bilateral C6, C7 dermatomal decreased sensation
  • Bilateral Hoffman`s reflex (pathologic)
  • Upper extremities brisk reflexes

 

 

 

 

 

 

Treatment-Multi-Level ACDF C4-7

Intraoperative Fluoroscopy Views

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Post-op CT scan

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 6 month F-Up X Rays

Patient Reported Outcome Scores (PROs)

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The patient post-surgery had significant improvement of neck and arm symptoms and resolution of myelopathjy. He rerutned to his normal everyday activities, including playing football


SPIRE LIVERPOOL HOSPITAL

PENNY LANE CLINIC

57 Greenbank Road,

Liverpool, Merseyside

L18 1HQ

Outpatient Appointments: Wed & Thurs 9am-8pm, Fri 5pm-8pm

Secretary: Lynne Ness

T1: 0151 733 7123

T2: 0151 522 1888

E:Lynn.Ness@spirehealthcare.com

  Book a Consultation  

SPIRE MURRAYFIELD HOSPITAL

WIRRAL

Holmwood Drive, 

Thingwall, Wirral,

CH61 1AU

Outpatient Appointments: Tues 5pm-8pm, Thurs 9am-1pm

Secretary: Karen Lindsay

T1: 0151 929 518

T2: 0151 929 5342

E: 

ROYAL LIVERPOOL HOSPITAL

NHS

Prescot Street,

Liverpool

L7 8XP

T: 0151 706 2000