Minimally Invasive Approach for Spinal Revision Surgery

Sudden Coma While Receiving Physical Therapy
October 26, 2021
Young college student with severe headache and a large intracerebral bleed
October 27, 2021

The goals of surgery were to achieve spinal stability, neural decompression, and re-establish a physiologic sagittal alignment. She had co-morbidities that precluded a more conventional open posterior approach with hardware revision. We therefore elected to perform an L3-4 Minimally Invasive Direct Lateral Interbody Fusion with Plate. This allowed for stability through the interbody device and lateral plate, indirect neural decompression by distracting the spinal canal and neuroforamina, and increase lordosis by lengthening the anterior aspect of the spine with placement of a hyperlordotic cage.

Patient tolerated the surgery well and attained near complete relief of her preoperative leg pain and chronic back pain. Incision was a little over one inch on her lateral side. Her postoperative pain was less significant given the indirect access to the spine which allowed for preservation of her paraspinal musculatures, and minimally invasive approach which maintained the integrity of the lateral muscle. She was discharged home on the day after surgery and was able to fully wean off her chronic narcotics.

Xavier P. J. Gaudin


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Preoperative X-ray (39° lumbar lordosis)
Postoperative X-ray (55° lumbar lordosis)


Minimally Invasive Approach for Spinal Revision Surgery

This is a 55 year-old-female who presented with progressively worsening axial low back pain and left lower extremity radiculopathy. She had a previous L4 to S1 posterior laminectomy with interbody fusion by another spine surgeon about three years prior. Imaging demonstrated L3-4 adjacent segment degeneration with spinal instability and stenosis. She additionally developed subsidence from her initial surgery, which resulted in loss of physiologic lordosis and presumptively accelerated the adjacent degenerative process. Her L4-S1 construct otherwise appeared to have a solid arthrodesis. Symptoms were debilitating and she had failed best medical management, therefore surgery was offered.

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