Mark Hornyak, MD

This is a 46 year-old female with back and right leg pain. She reported back pain for 4 years and leg pain severe for about 1 year. She had aching in her back and burning in the right, more than left, calf with walking. She also had numbness and tingling into the right calf and foot and tripping due to dragging her right foot. On exam, she has loss of sensation in the right foot and some weakness of the right ankle.

• All
• Pre-Op
• Intra-op
• Post-op

A lateral L-spine x-ray taken 3 years prior to surgery. It is relatively unremarkable.

MRI lumbar spine. Midline sagittal image (left) shows new malalignment between L4 and L5 (a spondylolisthesis). Axial (right) image shows severe cerntal canal stenosis at L4/5.

Paramedian sagittal images form the MRI show severe foraminal stenosis on the right (left image; red arrow), but mild on the left (right image).

A fluoroscopic image acquired during an epidural steroid injection. The patient received some relief from her right leg pain, but it was short-lived.

Patient’s rendering of symptoms upon presentation to neurosurgical office. Pain (left) and numbness/tingling (right). Her primary pain is in the right side of the low back and goes down her leg with numbness of the calf and foot consistent with a pinched nerve (a radiculopathy).

Dynamic x-rays of the lumbar spine. Note the new degeneration of the L4/5 disc space when compared with Figure 1. Also note the movement of L4 relative to L5 between extension (bending back, left) and flexion (bending forward, right)

Image acquired from the navigation workstation demonstrating the use of a tap to prepare the left L4 pedicle to receive a screw. This is done through a small skin incision (about ½ inch or 12mm).

Intraoperative photograph showing the navigational array, left-sided screw towers, and tubular retractor (8 cm).

Intraoperative video captured through the operative microscope. It shows the use of a high-speed drill in the tubular retractor removing bone to decompress the nerve in the neural foramen, and gain access to the disc space.

Image acquired from the navigation workstation demonstrating the image-guidance of the high-speed drill as access is gained.

Intraoperative photo taken using the operative microscope. The disc space can be visualized through the tubular retractor; it is the white square deep in the field.

Intraoperative photo taken using the operative microscope. The disc has been removed and a void into the disc space is demonstrated (*).

Intraoperative photo taken using the operative microscope. A metallic interbody device has been deployed in the disc space.

Postoperative x-rays showing lateral (side-view, left) and AP (front view, right) images of the lumbar spine with hardware in place. Note the correction of the spondylolisthesis.