E-Case report :

Multi Segment Degenerative Deformity T11-L5Dr. med. Patrick Weidle

Pre OP

Clinical Case – Spondylolisthesis

Dr. med. Patrick A. Weidle
Head of Musculoskeletal-Center MG
Head of Department for Orthopaedic-, Trauma-, Spine-Surgery and interventional Pain Therapy

Krankenhaus Neuwerk
Mönchengladbach
Germany

Pre OP:

  • 78 years old female patient
  • BMI 32.3 => Obesity
  • Bone quality DXA T-Score -2.8
    => Osteoporosis
  • Old fracture in L4 (23 months old)

Medical condition:

  • Severe Pain: VAS lumbar – 8/10 70%; VAS leg bilat – (r>l) 8/10 30%
  • Medication: WHO°III – Metamizol 3000mg; Oxycodon 30 mg; Amitriptylin 20 mg (coanalgesic drug)
  • Walking distance < 100 m with walking frame (claudicatio spinalis with severe pain ventral tigh bilat)
  • Painfree walking distance: 0 m

Radiographs & CT in sagittal and frontal views

MRI, sagittal view

Intra OP

Surgical strategy:

  • Open surgery
  • General anaesthetic
  • Complex repositioning spondylodesis T11 – L5 + Cement augmentation of pedicle screws in levels T11/T12/L1
  • Laminectomy L2-4
  • One-stage ventral fusion via TLIF L4/5 left + autograft
  • Bilateral posterior fusion with  auto- and Mastergraft (HA)
  • Secondary fusion of the ventral spine L1-4 lateral via XLIF (bicortical) if necessary

Use of the Neo Pedicle Screw System™

T11: Ø5.0 x 45mm

T12: Ø5.0 x 45mm

L1: Ø5.0 x 50mm

L2: Ø6.0 x 50mm

L3: Ø6.0 x 50mm

L4: Ø6.0 x 50mm

L5: Ø6.0 x 50mm

Universal, all-features-in-one screw design

Video showing Dr. Weidle inserting the pedicle screw, removing the K-wire and checking to confirm maintained polyaxiality

Cement augmentation of pedicle screws in levels T11/T12/L1. All Neo pedicle screws are cannulated and fenestrated for optimal flexibility.

Total time of surgery:

218 minutes

Blood loss:

960ml (300ml re-transfused)

Post OP

Published with the approval of Dr. med. Patrick Weidle

The cement augmentation option not available in the United States.