Case Studies Spinal fusions

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Cervical

Post-operative Xray of a patient with two-level cervical disc prolapse at C4-5 and C5-6. A two-level micro-discectomy was done and the spine was stabilized using iliac crest grafts (black arrows) and a plate and screws. Patient had excellent relief of arm pain following surgery and recovered well enough to return to work in 6 weeks.

Post-operative sagittal CT of the cervical spine showing a C5 & C6 corpectomy (drilling out of the vertebral body). Stabilisation has been achieved with a long segment iliac crest graft (arrows) and plate and screws. Patient had spondylotic cervical myelopathy (compression of the spinal cord due to degenerative disease in the cervical spine). Postoperative Xray at 3 months showing excellent bony fusion.

Intra-operative picture of a cervical lateral mass fusion. The spinal cord has been decompressed (white arrow) and the spine has been stabilized (from behind) using a lateral mass screw and rod system. This has been combined with a bone graft packed into the facet joints. The patient had severe spinal cord compression due to degenerative disease as well as instability of the spine. This required an approach from the back of the neck as the cord was compressed at multiple levels.

Pre operative (upper panel) and postoperative images of a patient with severe degenerative spine disease and spinal cord and nerve root compression (cervical myeloradiculopathy). Following two-level anterior cervical discectomy and fusion, the patient made a good recovery.

Patient with a C6-7 subluxation and cord compression with quadriparesis following a road traffic accident. Following surgery (anterior cervical discectomy and fusion) the patient made an excellent recovery and has returned to gainful employment.

Tuberculous spondylitis with severe deformity (arrow) of the upper cervical spine and cord compression with progressive weakness. Post operative Xray showing correction of the deformity and stabilization with a bone graft, plate and screws.

 

Spinal Fusions, Lumbar

Pre-operative and post-operative Xrays of a patient with Grade I listhesis of L5 over S1. The black arrow indicates where L5 should normally have been.

The patient had symptoms of nerve root compression and canal stenosis, with difficulty in walking. A decompression was required to relieve the pressure on the nerve roots combined with a fusion to stabilize the spine. Stabilization was done with trans-pedicular screw fixation and autologous iliac crest bone graft. Post-operative Xray shows reduction of the listhesis. Pre-operative and post-operative Xrays of a patient with Grade I L5-S1 listhesis.

Patient had severe leg pain with inability to walk. The black outline marks the borders of the vertebrae and the resultant step due to slippage of L5 over S1. Underwent a pedicle screw fixation of L5-S1 with a PLIF (posterior lumbar interbody fusion) using twin PEEK cages (arrow). These cages stabilize the spine from the front and the screw-rod construct stabilizes it from behind. The PEEK cages are radio-lucent which allows visualization of bony fusion post-operatively.

Post-operative images showing the implants (screws) in the bodies of L5 and S1 vertebrae. The PLIF cages are seen in the space between L5 and S1 (arrow). There is good reduction of the listhesis and the normal alignment of the spine has been restored.

Post-operative Xray of a patient with Grade I L4-L5 listhesis. Patient has undergone a L4-5 fusion with pedicle screws and a TLIF (transforaminal lumbar interbody fusion). The TLIF cage can be seen between the bodies of L4 and L5 (arrow).

Pre operative images of a patient with isthmic spondylolisthesis L5-S1 Grade II with back and leg pain. Patient underwent a decompression, discectomy and a pedicle screw fixation with TLIF (transforaminal lumbar interbody fusion).

Postoperative images showing the pedicle screws in place with a PEEK cage (arrow) in the interbody space inserted through the transforaminal route, thereby minimizing nerve root retraction.

An elderly gentleman with degenerative Grade I L4-5 slip and canal stenosis. Underwent a decompression followed by a simplified form of fusion. Bilateral L4-5 translaminar facet screw fusion is ideal for patients who are elderly- the procedure is short, simple and safe.

Others

Post-operative Xray of a patient with a fractured vertebra due to an injury. The fracture fragments were impinging on the spinal canal. From an anterior approach (through the chest) the fracture was approached, the fragments were removed, the spinal canal was decompressed and the spine stabilized using a cage (arrow) and a screw-rod system. The cage is packed with bone graft to achieve a good long-term fusion outcome.

Postoperative Xrays of a patient with fracture of L1 body, following transthoracic fusion, corpectomy and fusion (stand alone anterior).

Burst Vertebral Fracture

A 26 year old male presented with RTA and head injury with a burst fracture of the L4 vertebra and a large retropulsed fragment encroaching the spinal canal. He was neurologically intact.

Post-operative Xray after decompression and fusion at L4. The patient was mobilized a week after surgery and did well.

 
Sita Bhateja Speciality Hospital : Langford Gardens, Bangalore 560025. Ph. +91 80 22210701/22214074