E-Case report

Degenerative Disc Disease L4-L5 Dr. med. Jérôme Delambre

Pre OP

Clinical Case – DDD – Revision Surgery

Dr. med. Jérôme Delambre

Institut du Rachis parisien

Patient Information:

  • 45-year-old female patient
  • No medical history
  • Patient is suffering from chronic pain of disabling bilateral lumbosciatica in level L4-L5, disc arthrosis L4-L5. Bilateral spondylolysis with intersomatic pinching, and complicated by a grade I anterolisthesis.
  • This patient was treated surgically in 2018 with flexible osteosynthesis without release of the L4-L5 channel, which did not relieve her pain symptoms.

Pre OP radiographs

  • Severe L4-L5 intersomatic pinching can be observed in radiographs with moderate instabilities on dynamic images.
  • MRI confirms DDD with Modic T2 L4-L5 reaction
  • CT scans confirm the disc arthrosis as well as the bilateral spondylolysis L4-L5 with pedicle screws well positioned in L4-L5

Intra OP

Surgical planning

  • The painful lumbar situation can be explained by the L4-L5 disc involvement, instability due to spondylolysis
  • The nerve root pain can be explained by foraminal closure linked to the loss of disc height

Circumferential fusion correction, L4-L5, will be proposed in order to restore the distal height as well as the spondylolisthesis

This intervention is offered in 3 steps:

  1. Removal of implant material with bilateral arthrectomy and bilateral isthmectomy
  2. Correction of anterolateral fusion by an interbody fusion cage
  3. Instrumented arthrodesis L4-L5 using the Neo Pedicle Screw System™

Surgical procedure

Implant material to be removed

Neo pedicle markers placed

Interbody fusion cage; lateral LLIF approach and placement of an Avenue® L Lateral Lumbar Cage.

Post OP

Post OP radiographs

Arthrodesis L4-L5, Neo Pedicle Screw System™, 4x pedicle screws & 2 x straight rods

Post OP standing radiographs, frontal  views

Post OP standing radiographs sagittal views

Published with the approval of Dr. med. Jérôme Delambre