Board Certified Neurosurgeon Brain & Spine Care 860-889-9035
Mark Hornyak, MDBoard Certified Neurosurgeon
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Degenerative / Spine Case

Minimally Invasive Lumbar Fusion

46 year-old woman with back and right leg pain

Description

Back pain for 4 years
Leg pain severe for about 1 year
Aching in back
Burning in right, more than left, calf with walking
Numbness and tingling into the right calf and foot
Trips due to dragging her right foot
Has loss of sensation right foot and some weakness of the right ankle on examination

Gallery

Images

Figure 1A lateral L-spine x-ray taken 3 years prior to surgery. It is relatively unremarkable.
Figure 2MRI lumbar spine. Midline sagittal image (left) shows new malalignment between L4 and L5 (a spondylolisthesis). Axial (right) image shows severe central canal stenosis at L4/5.
Figure 3Paramedian sagittal images form the MRI show severe foraminal
Figure 4A fluoroscopic image acquired during an epidural steroid injection. The patient received some relief from her right leg pain, but it was short-lived.
Figure 5Patient’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.)
Figure 6Dynamic 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)
Figure 7Image 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).
Figure 8Intraoperative photograph showing the navigational array, left-sided screw towers, and tubular retractor (8 cm).
Figure 9Intraoperative 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.
Figure 10Image acquired from the navigation workstation demonstrating the image-guidance of
Figure 11Intraoperative 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.
Figure 12Intraoperative photo taken using the operative microscope. The disc has been removed and a void into the disc space is demonstrated (*).
Figure 13Intraoperative photo taken using the operative microscope. A metallic interbody device has been deployed in the disc space.
Figure 14Postoperative 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.

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