E-Case report :

Degenerative Disc Disease L5‑S1Dr. med. Santiago Solsona Espin

Pre OP

Clinical Case – Degenerative Disc Disease

Dr. med. Santiago Solsona Espin
Orthopaedic Surgeon & Trauma Surgeon
Specialty: Spine Surgery
Corachan Clinic
Barcelona, Spain

Patient Information

  • 52-year-old female patient, suffering from lumbar pain since >5 years.
  • The conservative treatment in rehabilitation and pain clinic has not been successfull.
  • In the last 8 months problems associated with radiculopathy S1 right side.
  • Functional disorders and Pain that affect her daily life activities:
    • Pain: VAS 8
    • Function: ODI 28 (56%)
  • EMG: Radiculopathy S1 right side.

Pre OP radiographs sagittal & frontal views

MRIs (sagittal & axial) confirm severe L5-S1 degenerative discopathy with disc collapse, osteochondrosis and small right side subarticular hernia, hypertrophy and facet synovitis together with asymmetric listhesis.

Surgical Strategy

It was decided to perform central and foraminal decompression + L5-S1 circumferential PL arthrodesis.

  • Instrumentation using the universal Neo Pedicle Screw System™.
  • Instrumentless compression maneuver through the use of the “Torque Limiters” with symmetrical reduction and sequential instrumentation assembly to fully control the applied forces.

Intra OP

Intra OP image confirming the anterior Neo Cage positioning

Surgical Procedure

Intraoperative data

  • Open surgical approach
  • General anesthesia
  • 1 level L5 – S1
  • Neo Pedicle Screws:
    • L5 Ø6.0 x 40mm
    • S1 Ø7.0 x 35mm
  • Neo Cage anatomical/curved 32mm, 7mm, 5°
  • Rod 40mm pre-bent
  • Allograft

K-wires insertion

Pedicle screws inserted & Polyaxiality check – Screw height

Rod selection & placement

The “Torque Limiter” allows us to pre-fix the rod/screw connection while preserving the screw polyaxiality

Final tightening of the rod to the screw heads at the cranial levels

Simultaneous and controlled reduction of the rod and definitive closure in the caudal level

Post OP

Post OP radiographs, sagittal & frontal views

Post OP CT, axial view

Thanks

Published with the approval of Dr. med. Santiago Solsona