Case Studies
Case Study: L4/5 Percutaneous Fusion
Performed by Micah Smith, MD
Ortho Northeast
Clinical History
The patient was a 43-year-old male who presented with debilitating low back pain and radiating bilateral leg pain. His past medical history included an L4/5 decompression several years prior with initial resolution of his leg pain. He did not have any other significant co-morbidities.
The patient was compliant with initial conservative therapies, which included physical therapy, oral medications, and epidural steroid injections. These measures did not provide relief of his symptoms. He was unable to stand or walk for more than 30 minutes and needed a cane for ambulation.
Implant Used
FlareHawk7 Cage
- 12mm height
- 11mm width
Lateral X-rays demonstrate improved foraminal space and solid arthrodesis at six months post-op.
Procedure
Dr. Smith recommended a minimally invasive one-level lumbar decompression and fusion with posterior instrumentation utilizing a cortical screw trajectory. An ultra-low-profile FlareHawk7 multidirectional expandable lumbar fusion device was utilized to accommodate a minimally invasive percutaneous approach. The stent-like design of FlareHawk7 allows the implant to be inserted as small as 7x7mm through an 8mm ID cannula before being deployed to 12x11mm, creating a larger cage within the disc space without sacrificing the patient’s anatomy during insertion.
Iliac crest autograft was harvested through a small incision. A reamer was utilized to take core samplings of the iliac crest to provide live stem cells to help facilitate fusion in the minimally invasive setting.
Access to the disc space was then obtained through a percutaneous approach. The FlareHawk7 instruments allow for gradual dilation to the low-profile, 9x9mm OD working cannula. Once the working cannula was placed, a hand drill, expandable paddle shaver, brushes, curettes, and pituitaries were used to perform a discectomy. The FlareHawk7 cage was then deployed, expanded, and backfilled with bone graft.
Outcomes
The patient was able to be discharged the same day as surgery and
experienced significant improvement of his low back pain and radiculopathy.
The patient’s AP and lateral X-rays demonstrated improved foraminal space
and solid arthrodesis at six months post-op. The patient is pleased with his surgical outcome, no longer uses a cane, has resumed activities of daily living, and is back to riding his bike.
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