Case Studies
Case Study: An Awake MIS TLIF
Performed by Ernest Braxton, MD, MBA
Vail Summit Orthopaedics
Clinical History
The patient was a 73-year-old male who presented with a four-year history of continued low back and left lower extremity pain. He failed numerous attempts of conservative therapy including a left L4-5 facet aspiration and a L5-S1 transforaminal injection.
The patient was diagnosed with L4-5 spondylolisthesis with severe neuroforaminal stenosis. His preoperative Oswestry Disability Index was 22, and he reported his pain was a “4” on a scale of 1 to 10, had persisted for the last four years, and prohibited him from engaging in favorite activities of cycling and golfing.
Procedure
The patient had a history of several days of postoperative nausea and vomiting with the use of general anesthetics. With that in mind, Dr. Braxton and the patient made the choice to undergo an awake L4/5 transforaminal lumbar interbody fusion.
A spinal block was used for anesthesia. Dr. Braxton then accessed the spine with navigation for placement of an 18mm tubular retractor in a modified Kambin’s approach. This allowed him to perform a TLIF with minimal removal of the superior articular process. Next, he decompressed the spine under microscope visualization prior to placement of the TiHawk9 implant.
Outcomes
The patient reported minimal pain on postoperative day 1 (NRS pain score was 2 out of 10) and did not require IV or postoperative narcotic medication for pain control. The patient was able to resume cycling and golfing soon after surgery.
This case is a great example of the ability to maintain lordosis from a posterior approach to the spine, achieving the following final spinopelvic parameters:
LL: 61 PI: 52 PI-LL: 8 PT: 16
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