Transpsoas Lateral Interbody Fusion with RISE®-L Expandable SpacerMichael Gallizzi, MD, MS Minimally Invasive Spine Surgeon Cornerstone Orthopedics and Sports Medicine Denver, CO

CASE STUDY SERIES

Patient History

61-year-old female presented with the following:

• Severe left sided hip flexion and quadriceps weakness

• 3/5 hip flexion strength rating

• Significant left thigh dysesthesia and paresthesia

• Left leg pain and back pain both rated as 8/10

The patient failed non-operative treatment including, injections, physical therapy,

and medication management. She had no prior lumbar spine surgery.

PREOPERATIVE AP RADIOGRAPH

PREOPERATIVE LATERAL RADIOGRAPH

PREOPERATIVE L2-L3 AXIAL MRI

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Results

The patient had immediate resolution of her left thigh dysesthesia and a 1 motor grade improvement in hip flexion and quad extension post-operatively. Left leg motor, sensory function, and back pain continued to improve at her 3 month postoperative visit. Radiographs at 3 months demonstrated approximately 1mm of retrolisthesis correction with significant improvement in alignment, disc and foraminal height, and lordosis.

The RISE®-L implant allowed for restoration of her severe degenerative L2-L3 level disc height, correcting both retrolisthesis and neuroforaminal stenosis, as well as an improvement in segmental and overall lumbar lordosis.

Surgical Treatment

The patient’s imaging showed signs of instability, disc height loss, and trans-neuroforaminal/far lateral disc compression. AP radiographs demonstrated left lateral listhesis at L2-L3 with slight axial rotation and retrolisthesis on the lateral film. Stabilization and decompression were required to manage her symptoms.

Given the advanced L2-L3 disc degeneration and trans-neuroforaminal stenosis, I determined an implant with a small starting height and ability to expand in situ was necessary. My chosen surgical treatment was an L2-L3 lateral lumbar interbody fusion with a RISE®-L 10° lordotic expandable cage, supplemented with CREO MIS® percutaneous pedicle screw and rod fixation.

SUMMARY

Pre-Op Post-Op

L2-L3 Lordosis 1° 6°

Overall Lumbar Lordosis 41° 47°

Pelvic Incidence 43° 43°

L2-L3 Disc Height 1.5mm 9.5mm

Leg and Back Pain Rating 8/10 0/10

3-MONTH POSTOPERATIVE AP RADIOGRAPH

3-MONTH POSTOPERATIVE LATERAL RADIOGRAPH