E-Case report
Multi Segment Degenerative Deformity T11-L5Dr. med. Patrick Weidle
![February-–-Dr.-Kuhr-&-Dr.-Kirschbaum](https://neo-medical.com/wp-content/uploads/2021/02/February-–-Dr.-Kuhr-Dr.-Kirschbaum.png)
Pre OP
![Vector](https://neo-medical.com/wp-content/uploads/2021/01/Vector-3.png)
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
![Rectangle-13](https://neo-medical.com/wp-content/uploads/2021/01/Rectangle-13.png)
![patrick-A-weidle](https://neo-medical.com/wp-content/uploads/2021/05/patrick-A-weidle.png)
![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)
![Rectangle-14](https://neo-medical.com/wp-content/uploads/2021/01/Rectangle-14.png)
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
![Rectangle-15](https://neo-medical.com/wp-content/uploads/2021/01/Rectangle-15.png)
Radiographs & CT in sagittal and frontal views
![preop](https://neo-medical.com/wp-content/uploads/2021/05/preop.png)
![ligne](https://neo-medical.com/wp-content/uploads/2021/01/ligne.png)
MRI, sagittal view
![ligne-2b](https://neo-medical.com/wp-content/uploads/2021/01/ligne-2b-1.png)
![preop-2](https://neo-medical.com/wp-content/uploads/2021/05/preop-2.png)
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
![Rectangle-14](https://neo-medical.com/wp-content/uploads/2021/01/Rectangle-14.png)
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
![intraop](https://neo-medical.com/wp-content/uploads/2021/05/intraop.png)
![Rectangle-15](https://neo-medical.com/wp-content/uploads/2021/01/Rectangle-15.png)
![Vector](https://neo-medical.com/wp-content/uploads/2021/01/Vector-3.png)
![intraop-2](https://neo-medical.com/wp-content/uploads/2021/05/intraop-2.png)
Video showing Dr. Weidle inserting the pedicle screw, removing the K-wire and checking to confirm maintained polyaxiality
![intraop-3](https://neo-medical.com/wp-content/uploads/2021/05/intraop-3.png)
![Rectangle-10](https://neo-medical.com/wp-content/uploads/2021/01/Rectangle-10.png)
![Rectangle-14](https://neo-medical.com/wp-content/uploads/2021/01/Rectangle-14.png)
Cement augmentation of pedicle screws in levels T11/T12/L1. All Neo pedicle screws are cannulated and fenestrated for optimal flexibility.
![intraop-4](https://neo-medical.com/wp-content/uploads/2021/05/intraop-4-1.png)
![Rectangle-15](https://neo-medical.com/wp-content/uploads/2021/01/Rectangle-15.png)
![Rectangle-14](https://neo-medical.com/wp-content/uploads/2021/01/Rectangle-14.png)
Total time of surgery:
218 minutes
Blood loss:
960ml (300ml re-transfused)
![Rectangle-13](https://neo-medical.com/wp-content/uploads/2021/01/Rectangle-13.png)
![intraop-5](https://neo-medical.com/wp-content/uploads/2021/05/intraop-5.png)
![Rectangle-11](https://neo-medical.com/wp-content/uploads/2021/01/Rectangle-11.png)
![Rectangle-15](https://neo-medical.com/wp-content/uploads/2021/01/Rectangle-15.png)
Post OP
![post-op](https://neo-medical.com/wp-content/uploads/2021/05/post-op.png)
![ligne-2b](https://neo-medical.com/wp-content/uploads/2021/01/ligne-2b-1.png)
Published with the approval of Dr. med. Patrick Weidle
The cement augmentation option not available in the United States.