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POSTERIOR LUMBAR INTERBODY FUSION (PIF) AND DISTRACTION USING LOCAL ANESTHESIA: FIRST CASES USING FULLY CT-GUIDED TECHNIQUE 2012

Interventional Spine

Luigi, Manfre, MD

Paper/Non-Mentor

Purpose

We performed fully CT-guided Posterior Interbody Fusion (PIF) with pedicle screw fixation and vertebra distraction to treat degenerative lumbar L4-L5 and L5-S1 spondylolisthesis with severe bilateral sciatica.

Methods & Materials

3 Patient were suffering for L4 - L5 and 1 with L5-S1 nerve root compression related to neural foramina stenosis due to spondylolisthesis with or without spondylolisis. VAS scale was adopted to pain grading (mean value was 8). Caliber of the foramina were measured on pre- and post-op CT 2D recons studies. As self-tapping screws were used and a couple of 50 to 60mm rods were applied, directly through the working cannula at lower level selected, moving towards the upper screws, and a rod pusher was used to fix the rods to screws. The procedure was easy to apply with a total surgical time of 90 minutes. The neural foramina were investigated with CT scan reconstruction on sagittal plane demonstrating marked widening after the PIF application.

Results

The left leg pain completely disappeared in 2 weeks and the patients remained painless at the 3 months follow-up control. Post-op VAS scale was 2 (mean value). No complication was observed in the immediate and late follow-up, and the patients well tolerated all the procedure, despite no general anesthesia was performed.

Conclusion

Chronic drug-resistent sciatica can occur in patients affected bu neural foramina narrowing secondary to degenerative anterior lysthesis of a lumbar vertebra. CT-guided pedicle screws fixation and distraction of vertebra could be useful in such conditions.To our knowledge, no other papers about CT-guided PIF procedure are found in the literature.

References/Financial Disclosures

Effectiveness of spinal fusion versus structured rehabilitation in chronic low back pain patients with and without isthmic spondylolisthesis: a systematic review. Wood KB, Fritzell P, Dettori JR, Hashimoto R, Lund T, Shaffrey C. Spine (Phila Pa 1976). 2011 Oct 1;36(21 Suppl):S110-9 Fusion versus nonoperative management for chronic low back pain: do comorbid diseases or general health factors affect outcome? Choma TJ, Schuster JM, Norvell DC, Dettori JR, Chutkan NB. Spine (Phila Pa 1976). 2011 Oct 1;36(21 Suppl):S87-95

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