case study: L4-5 Lateral Interbody Fusion and L4-5 Post Decomp & Fusion

 

PATIENT HISTORY

Patient is a 65 year old male with neck and back pain caused by an automobile accident.

 

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CHALLENGE

Patient complains of mid-back pain, lower back pain and has numbness and tingling to neck which travels down to whole left side. When standing for long periods, the patient has tightening pain in the mid and lower back. Patient takes Hydrocodone to help relieve pain and currently does physical therapy.

 

SOLUTION:

Despite physical therapy, injections and advised weight loss, the patient is still suffering from tightness in the shoulders, neck and back and continues to have lower back pain. The patient decided to undergo surgical intervention.

 

DIAGNOSIS
The patient suffers from L4-5 vacuum disc, Mild grade 1 L4-5 spondylolithesis, L2-3 and L4-5 stenosis and sacralized L5.

 

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PLAN OF TREATMENT:

In order to achieve adequate decompression at the L4-5 the surgeon will inadvertently create an iatrogenic instability by the disruption of the posterior elements by excising a significant portion (at least 50%) of the facet joints bilaterally. The combination of this procedure coupled with a grade 1 L4-5 spondylolisthesis will destabilize this affected level and thus we elected to add instrumentation to fuse and stabilize the L4-5.

 

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SURGERY PERFORMED:

L4-5 Lateral Interbody Fusion and L4-5 Post Decomp & Fusion.