Truumees E, Shen F.
SpineLine. 2010;JanFeb 10(1):21-24.
What would you do in this case?
We presented this case to our medical-interventional specialists and surgical specialists of the SpineLine Editorial board. Please click on the questions below to see their responses and post your comments.
For Medical/Interventional Specialists
- Would you have referred this patient to a surgeon? Are there other M/I modalities that should have been tried first?
For Surgical Specialists
- Was an anterior approach required? Could this have been done with a far lateral (X-LIF or DLIF) approach in the mid-lumbar spine and an alternate approach at L5-S1? Would a posterior osteotomy have been better?
- Were the appropriate levels selected? Should the approach have gone higher into the thoracic spine (at least T10, for example)? Was extension to the pelvis necessary or could the surgery have stopped at the sacrum?
- Given that this patient remains osteoporotic, would augmentation of the pedicle screws with polymethylmethacrylate have been suggested? Would you brace this patient postoperatively? If so, with what brace and for how long?
- What type of bone graft material would you suggest? Anteriorly? Posteriorly? Would you use BMP? If so, how much?
- Would measurement of the pelvic incidence (PI) or other measures not provided here have changed your surgical plan?
- How long would you restrict the patient’s activities after surgery? Would you send this patient to physical therapy after surgery? When? When would you estimate she could return to work as a floor nurse?
- Would you use a drain? For how long? When would you let the patient eat?
- Are there other tricks or pearls for managing this type of patient we should know about?