Case Studies
Resolving Severe Lumbar Stenosis with LineSider® Spinal System Modular Screws
Performed by Dr. Shivam Upadhyaya
South Florida Orthopaedics
Clinical History
AGE/SEX
76-year-old male
SYMPTOMS
The patient presented with intermittent severe low back pain (LBP) and progressively worsening right lower extremity radiculopathy. He had been experiencing symptoms for two years and had undergone several months of physical therapy, medications (NSAIDs, muscle relaxants, oral steroids), and multiple epidural steroid injections without lasting relief. There was no history of prior surgery.
PRE-OP PAIN
The patient reported baseline Visual Analog Scale (VAS) leg and back scores of 9/10 with symptoms causing significant disability and impairing activities of daily living.
PATHOLOGY
Preoperative MRI revealed moderate to severe central stenosis with severe right paracentral and foraminal stenosis due to a large right-sided synovial cyst.
Implants Used
LineSider Posterior Modular Screws (6.5x45mm) with 5.5mm-diameter titanium curved rods
Procedure
After discussing surgical and nonsurgical options, and considering the exhaustion of conservative treatments, Dr. Upadhyaya and the patient opted for an L4-5 laminectomy with synovial cyst excision and posterolateral instrumented fusion under general anesthesia.
Dr. Upadhyaya utilized the LineSider modular pedicle screw system to place bilateral pedicle shanks at L4 and L5 using a cortical trajectory. With the modular shanks securely in place, central decompression with en bloc synovial cyst excision was performed. The absence of tulips during the screw placement provided an unobstructed view and workspace until decompression was completed and final instrumentation was achieved. This approach allowed the surgery to be performed through a 2.5 cm incision. The patient was discharged within 24 hours with complete symptom resolution.
Outcomes
The patient completed 2-week, 6-week, and 3-month follow-up visits, exhibiting complete wound healing and symptom resolution with VAS leg and back scores of 0/10. He returned to all activities of daily living and, by the 3-month follow-up, resumed sports at his preoperative level. The patient experienced no complications and discontinued all prescription medications.
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