E-Case report

Trauma Fractures L2 & L4
Posterior fixation T12 – L5
Tomas von Koschitzky, MD

Pre OP

Clinical Case – Trauma Fractures L2 & L4
Posterior fixation T12 – L5

Tomás von Koschitzky, MD
Orthopaedic/ Trauma Surgeon
MVZ Rothenburg
Rothenburg ob der Tauber

Patient Information

  • Female patient diagnosed with vertebral fractures in L2 and L4
  • Good bone quality
  • Patient has a nicotine abuse
  • Hypertonus
  • Suffering from depression

Planned Surgery:

  1. Posterior fixation T12 – L5
  2. Percutaneous MIS surgery
  3. Intermediate index screws to be placed in the fractured level L4
  4. Neo ADVISE™ to be used

Pre OP CTs
Sagittal, frontal & axial views

Intra OP

Access and first K-wires placed

Pedicle screws insertion

Posterior fixation with Neo Pedicle Screw System™

Totally 10 pedicle screws placed over the levels T12 – L5

  • T12 –  2 x Ø6.0×45 mm
  • L1 –   2 x Ø6.0×50 mm
  • L3 –   2 x Ø6.0×50 mm
  • L4 –   2 x Ø7.0×35 mm, index screws
  • L5 –   2 x Ø7.0×45 mm

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 screen relative to the screw heads in relation to the selected straight 160mm rods.

The screw adjustments are color-coded into the virtual screw heads. The colors green and orange, indicate different levels of adjustments.

Videos are showing all steps using Neo ADVISE™, the scene analysis, mapping of the guide towers, data access, and data analysis in both the left and the right side.

Rod bending using the rod visualization in the iPad screen as template for boththe sagittal and the coronal planes.

Placing left side rod and set screw tightening L5

Placing right side rod and set screw tightening L5

Final tightening of all set screws

Radiographs after final fixation of the posterior construction and removal of the instrumentation.

Post OP

Post OP radiographs

  • Intra OP Blood loss:  300 ml
  • Duration of surgery: 120 min
  • Patient was discharged from the hospital after 7 days
  • The posterior instrumentation was removed after fracture healing, 8 months postoperatively.

Published with the approval of Tomás von Koschitzky, MD