E-Case report
Degenerative Disc Disease (DDD)
Spinal Canal Stenosis-Revision surgery
Posterior fixation T9 – L2David Schul, MD
Martin Reiser, MD
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![image4](https://neo-medical.com/wp-content/uploads/2023/12/image4.png)
Pre OP
![Vector](https://neo-medical.com/wp-content/uploads/2021/01/Vector-3.png)
Clinical Case – Degenerative Disc Disease (DDD)
Spinal Canal Stenosis
Revision surgery
Posterior fixation T9 – L2
Neo ADVISE™
Dr. med. David Schul, Neurosurgeon
Dr. med. Martin Reiser, Neurosurgeon
InnKlinikum
Mühldorf, Germany
![image7](https://neo-medical.com/wp-content/uploads/2023/12/image7.png)
![Rectangle-13](https://neo-medical.com/wp-content/uploads/2021/01/Rectangle-13.png)
![image5](https://neo-medical.com/wp-content/uploads/2023/12/image5.png)
Dr. med. David Schul
![image6](https://neo-medical.com/wp-content/uploads/2023/12/image6.jpg)
Dr. med. Martin Reiser
![Rectangle-11](https://neo-medical.com/wp-content/uploads/2021/01/Rectangle-11.png)
![Rectangle-10](https://neo-medical.com/wp-content/uploads/2021/01/Rectangle-10.png)
Patient Information
83-year-old female patient diagnosed with large calcified disc herniation and spinal canal stenosis in level T10/11.
The patient has earlier been treated with a L1 vertebral body replacement including dorsal stabilization T12 – L2. In addition, kyphoplasty in level T8.
Bone quality: Good
Pain (VAS): Minor pain (2-3)
Function (ODI): Moderate disability (35)
Neurological status: Paraparesis, patient couldn´t walk anymore
Hypertension
Planned Surgery:
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- Revision surgery, removing of the dorsal instrumentation, pedicle screws in T12 and L2
- Open surgery, midline approach
- Posterior fixation T9 – L2
- Neo ADVISE™ to be used for a correct rod bending
![ligne-2b](https://neo-medical.com/wp-content/uploads/2021/01/ligne-2b-1.png)
![Rectangle-14](https://neo-medical.com/wp-content/uploads/2021/01/Rectangle-14.png)
Pre OP MRI & CTs, sagittal, frontal and axial views
![image8-3 marco grosso pre operation representation](https://neo-medical.com/wp-content/uploads/2023/12/image8-3.jpg)
![image10 marco grosso pre operation representation](https://neo-medical.com/wp-content/uploads/2023/12/image10.jpg)
![image9 marco grosso pre operation representation](https://neo-medical.com/wp-content/uploads/2023/12/image9-e1701947527281.jpg)
![image11 marco grosso pre operation representation](https://neo-medical.com/wp-content/uploads/2023/12/image11.jpg)
![Rectangle-15](https://neo-medical.com/wp-content/uploads/2021/01/Rectangle-15.png)
Intra OP
![ligne](https://neo-medical.com/wp-content/uploads/2021/02/ligne-e1613577992934.png)
Surgical procedure
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- Patient placed in prone position
- General anesthesia – ITN & TIVA
- Open approach, midline cut
- Removal of old pedicle screws in level T12 & L2
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![image12](https://neo-medical.com/wp-content/uploads/2023/12/image12.jpg)
Access and K-wires placement
![ligne-2b-1-reverse](https://neo-medical.com/wp-content/uploads/2022/01/ligne-2b-1-reverse.png)
- Costotransversectomy T9-11 with sequential removal of the sequestrum
- Laminectomy and bilateral decompression with microscope T10/11
- K-Wire placement (lateral) in levels T9-T12 and L2 using navigation BrainLab
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Posterior fixation with Neo Pedicle Screw System™
Totally 10 pedicle screws placed over the 5 levels T9 – L2
- T9 2 x Ø6.0x40mm
- T10 2 x Ø6.0x40mm
- T11 2 x Ø6.0x45mm
- T12 2 x Ø6.0x50mm
- L2 2 x Ø7.0x50mm
![image13 marco grosso pre operation representation](https://neo-medical.com/wp-content/uploads/2023/12/image13-e1701948187370.jpg)
![Rectangle-15](https://neo-medical.com/wp-content/uploads/2021/01/Rectangle-15.png)
![ligne](https://neo-medical.com/wp-content/uploads/2021/02/ligne-e1613577992934.png)
Usage of Neo ADVISE™
![image14](https://neo-medical.com/wp-content/uploads/2023/12/image14.jpg)
ADVISE™ scene analysis
![ligne-2b](https://neo-medical.com/wp-content/uploads/2021/01/ligne-2b.png)
![Vector](https://neo-medical.com/wp-content/uploads/2021/01/Vector-3.png)
Results from using the Neo ADVISE™ in both sides, with visualizations of the rods in both the sagittal and the coronal planes shown in the iPad screen.
Rod selection:
2x Titanium rods 160mm straight
ADVISE™ 152/155mm
![image18](https://neo-medical.com/wp-content/uploads/2023/12/image18.jpg)
![image17](https://neo-medical.com/wp-content/uploads/2023/12/image17.jpg)
![image16](https://neo-medical.com/wp-content/uploads/2023/12/image16.jpg)
![image15](https://neo-medical.com/wp-content/uploads/2023/12/image15.jpg)
![Rectangle-10](https://neo-medical.com/wp-content/uploads/2021/01/Rectangle-10.png)
![ligne](https://neo-medical.com/wp-content/uploads/2021/02/ligne-e1613577992934.png)
After the final fixation of the posterior construction and removal of the instrumentation.
A cross connector was inserted to increase stability.
![image19](https://neo-medical.com/wp-content/uploads/2023/12/image19.jpg)
![Rectangle-14](https://neo-medical.com/wp-content/uploads/2021/01/Rectangle-14.png)
Radiographs after final fixation of the posterior construction and removal of the instrumentation.
![image20 marco grosso pre operation representation](https://neo-medical.com/wp-content/uploads/2023/12/image20-e1702381116110.jpg)
![image21 marco grosso pre operation representation](https://neo-medical.com/wp-content/uploads/2023/12/image21-e1702374826747.jpg)
![image22 marco grosso pre operation representation](https://neo-medical.com/wp-content/uploads/2023/12/image22-e1702374932312.jpg)
![Rectangle-15](https://neo-medical.com/wp-content/uploads/2021/01/Rectangle-15.png)
Post OP
![Vector](https://neo-medical.com/wp-content/uploads/2021/01/Vector-3.png)
Post OP CT scans
- Intra OP Blood loss: ca. 500 ml
- Duration of surgery: 500 min
- Pain (VAS): 2-3
- Significantly better neurological status, the patient could leave the hospital walking
- Patient was discharged from the hospital after 7 days
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![image23](https://neo-medical.com/wp-content/uploads/2023/12/image23.jpg)
![image25](https://neo-medical.com/wp-content/uploads/2023/12/image25.jpg)
![Rectangle-10](https://neo-medical.com/wp-content/uploads/2021/01/Rectangle-10.png)
Published with the approval of Dr. David Schul and Dr. Martin Reiser