E-Case report

Disc herniation & bilateral foraminal stenosis
L4/5 MIS TLIF in ASC outpatient procedure
Ali M. Maziad, MD PhD

Pre OP

Clinical Case – Disc herniation & Bilateral foraminal stenosis

L4/5 MIS  TLIF in ASC* outpatient procedure

Ali M. Maziad, MD PhD
Orthopedic Spine Surgeon
Maziad Spine Institute
Miami, FL, USA

*Ambulatory Surgical Center

Patient Information:

35-year-old male patient bodybuilder with chronic low back pain (LBP) and a recent history of motor vehicle accident. Left lower extremity radicular pain.

  • Height: 71.0 in/1.80 m
  • Weight: 250 lbs/113 kg
  • BMI: 34.9 / BSA: 2.3

Diagnoses:

  1. L4/5 disc herniation
  2. Bilateral foraminal stenosis with retrolisthesis and instability on flexion-extension view
  3. No radiculopathy

Pre OP radiographs, frontal and sagittal views

marco grosso pre operation representation
marco grosso pre operation representation

Pre OP MRI and radiograph sagittal view

marco grosso pre operation representation

Pre OP MRIs sagittal and axial views

marco grosso pre operation representation
marco grosso pre operation representation
marco grosso pre operation representation
marco grosso pre operation representation

Intra OP

OR-strategy:

  • Thoraco-Lumbar Interfascial Plane (TLIP) block, injection of local anesthetics, in L3 – L4.
  • L4/5 minimally invasive TLIF – left,  to be performed as an outpatient procedure in the ASC.
  • Planning to use the Neo Cage System ™ & Neo Pedicle Screw System™  for fusing the segment L4/5.

Intra OP radiograhs for the planning of the surgical access.

L5 - Access and placing the K-wire, left side

L4 - Access and placing the
K-wire, left side

Inserting at the left side 2 pedicle screws,

Neo Pedicle Screw System™

L4: Ø6.0x45 mm

L5: Ø6.0x45 mm

Access and placing  K-wires, right side

Disc space preparation and placement of Neo Cage anatomical/straight 32mm, 12mm, 0°

Placement of the Neo Cage

After the placement of the Neo cage, another 2 Neo pedicle screwswere inserted at the left side,

L4:  Ø6.0x45 mm

L5:  Ø6.0x45 mm

 

2  X titanium rods, straight 40mm/45mm, were placed.

Radiographs, frontal and sagittal views

Total time of surgery: 2 hours and 10 minutes
Estimated blood loss: 15 cc

marco grosso pre operation representation
marco grosso pre operation representation

Post OP

Radiographs after the final fixation of the posterior construction, and removal of the instrumentation

Post OP radiographs, 1 week after the surgery, frontal and sagittal views.

Patient was discharged from the clinic 1 hour after surgery.

He consumed minimal narcotics on the first 48 hours.

Pain resolved afterwards and he used Tylenol as needed.

Reported resolution of lower back pain and no radicular pain 1 week postoperatively.

Follow up

Radiographs at 6 weeks Follow Up, frontal and sagittal views

marco grosso pre operation representation
marco grosso pre operation representation

Radiographs after the final fixation of the posterior construction, and removal of the instrumentation

Follow up

Radiographs at 3 months Follow Up, frontal and sagittal views

Post OP radiograph at 5 months FU confirms the stable clinical result.

Picture  showing the nicely healed minimal incisions at the lower back of the patient.

Published with the approval of Dr. Ali Maziad