E-Case report
Burst Fracture L1
Posterior fixation T11 – L3 Christoph Grimm, MD
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Pre OP
![Vector](https://neo-medical.com/wp-content/uploads/2021/01/Vector-3.png)
Clinical Case – Burst Fracture L1
Posterior fixation T11 – L3
Neo ADVISE™
Trauma module, Marker Detection
Dr. Christoph Grimm
Neurosurgeon
Bezirkskliniken Schwaben
Standort Günzburg
Günzburg, Germany
![image6](https://neo-medical.com/wp-content/uploads/2023/09/image6-1.jpg)
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![ligne](https://neo-medical.com/wp-content/uploads/2021/02/ligne-e1613577992934.png)
Patient Information:
79-year-old female patient suffered a burst fracture in L1 level
- A4 type fracture involving the posterior wall, fragmented
- Spinal stenosis at the fractured level
- Compromised bone quality
Planned Surgery:
- Percutaneous MIS surgery, lateral approach
- Midline approch for navigation star (Brainlab Navigation)
- Posterior fixation T11 – L3
- Intermediate screws in the fracturd level L1
- Cement augmented screws T11 and L3
- Neo ADVISE™ Marker Detection Method to be used
![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 radiographs & CT, sagittal and frontal views
![image8 marco grosso pre operation representation](https://neo-medical.com/wp-content/uploads/2023/09/image8-1.jpg)
![image9 marco grosso pre operation representation](https://neo-medical.com/wp-content/uploads/2023/09/image9-2.jpg)
![image7](https://neo-medical.com/wp-content/uploads/2023/09/image7-1.jpg)
![Rectangle-15](https://neo-medical.com/wp-content/uploads/2021/01/Rectangle-15.png)
Intra OP
![image10](https://neo-medical.com/wp-content/uploads/2023/09/image10-2.jpg)
![image11](https://neo-medical.com/wp-content/uploads/2023/09/image11-2.jpg)
![image12](https://neo-medical.com/wp-content/uploads/2023/09/image12-2.jpg)
Lateral access incisions, and midline access for the navigation star, Brainlab drillguide
Navigating and placing the first K-wire
![ligne-2b](https://neo-medical.com/wp-content/uploads/2021/01/ligne-2b.png)
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All 10 K-wires have been placed
![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)
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![image18 3](https://neo-medical.com/wp-content/uploads/2023/09/image18-3.jpg)
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![image19](https://neo-medical.com/wp-content/uploads/2023/09/image19-1.jpg)
Posterior fixation with Neo Pedicle Screw System™. Starting the pedicle screws insertion
![ligne-2b-1-reverse](https://neo-medical.com/wp-content/uploads/2022/01/ligne-2b-1-reverse.png)
![Vector](https://neo-medical.com/wp-content/uploads/2021/01/Vector-3.png)
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![image21 2](https://neo-medical.com/wp-content/uploads/2023/09/image21-2.jpg)
Totally 10 pedicle screws were placed over the levels T11 – L3
Intermediate shorter screws in the fractured L1
- T11 – 2 x Ø5.0x45 mm polyaxial
- T12 – 2 x Ø5.0x45 mm polyaxial
- L1 – 2 x Ø5.0x35 mm polyaxial
- L2 – 2 x Ø5.0x50 mm polyaxial
- L3 – 2 x Ø6.0x50 mm polyaxial
![Rectangle-15](https://neo-medical.com/wp-content/uploads/2021/01/Rectangle-15.png)
Cement augmentation of pedicle screws in levels T11 and L3, 1ml cement/screw.
All Neo system pedicle screws are cannulated and fenestrated to faciliate this surgical step.
![image25](https://neo-medical.com/wp-content/uploads/2023/09/image25.jpg)
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Usage of Neo ADVISE™ Marker Detection Method
![image28](https://neo-medical.com/wp-content/uploads/2023/09/image28.jpg)
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The QR code Markers are attached to the guide towers
The Scene Analysis is performed
![Vector](https://neo-medical.com/wp-content/uploads/2021/01/Vector-3.png)
Finding and mapping the Markers
![image31](https://neo-medical.com/wp-content/uploads/2023/09/image31.jpg)
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![ligne](https://neo-medical.com/wp-content/uploads/2021/02/ligne-e1613577992934.png)
Results from using the Neo ADVISE™ in both the left and the right side
Visualizations of the rods in both the sagittal and the coronal planes in the iPad screens
![image35](https://neo-medical.com/wp-content/uploads/2023/09/image35.jpg)
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Rod selection: 2 x Titanium rods 160mm straight, shortened to 135mm
![ligne-2b](https://neo-medical.com/wp-content/uploads/2021/01/ligne-2b-1.png)
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![image37](https://neo-medical.com/wp-content/uploads/2023/09/image37-e1700146640592.jpg)
Rod bending using the rod visualization in the iPad screen as template for the sagittal shape of both rods.
![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)
Rod placement & Final set screw tightening
![image41](https://neo-medical.com/wp-content/uploads/2023/09/image41.jpg)
![image42](https://neo-medical.com/wp-content/uploads/2023/09/image42.jpg)
![image43](https://neo-medical.com/wp-content/uploads/2023/09/image43.jpg)
![image43](https://neo-medical.com/wp-content/uploads/2023/09/image43.jpg)
![image45](https://neo-medical.com/wp-content/uploads/2023/09/image45.jpg)
Rod selection: 2 x Titanium rods 160mm straight, shortened to 135mm
![ligne-2b](https://neo-medical.com/wp-content/uploads/2021/01/ligne-2b-1.png)
![Vector](https://neo-medical.com/wp-content/uploads/2021/01/Vector-3.png)
Radiographs after final fixation of the posterior construction and removal of the instrumentation
![image47](https://neo-medical.com/wp-content/uploads/2023/09/image47.jpg)
![image48](https://neo-medical.com/wp-content/uploads/2023/09/image48.jpg)
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Closure of incision
![Rectangle-15](https://neo-medical.com/wp-content/uploads/2021/01/Rectangle-15.png)
Post OP
Radiographs after the final fixation of the posterior construction, and removal of the instrumentation
![ligne](https://neo-medical.com/wp-content/uploads/2021/02/ligne-e1613577992934.png)
Post OP CTs
![image49](https://neo-medical.com/wp-content/uploads/2023/09/image49-1.jpg)
![image50](https://neo-medical.com/wp-content/uploads/2023/09/image50-1.jpg)
![image51](https://neo-medical.com/wp-content/uploads/2023/09/image51-1.jpg)
- Blood loss (intraoperative, total): 350 ml
- Duration of surgery: 210 min
- Post OP VAS: 2
- Neurological status: No problem
- Patient was discharged from the hospital after 7 days.
![ligne-2b](https://neo-medical.com/wp-content/uploads/2021/01/ligne-2b.png)
Published with the approval of Dr. Christoph Grimm