Case Studies


Case Study: L5/S1 Bilateral PLIF

Performed by Rohit Vasan, MD
James A. Haley Veterans' Hospital

Clinical History

The patient is a 38-year-old male U.S. Armed Forces veteran with three previous disc intervention procedures, one at L4-5 and two at L5-S1. The patient maintains an extremely active lifestyle.

For the past two years, the patient had progressively increasing severe L5 and S1 left leg radiculopathy, as well as severe axial back pain, and refractory to nonoperative therapy including physical therapy and pain management.

Patient presented with a large left-centric disc herniation at L5-S1 along with significant loss of disc and foraminal height. 


Implants Used

Two Accelus TiHawk11 cages with a combined width of 34mm.

  • 10mm height
  • 17mm width
  • 25mm length
  • 6° of lordosis


Given the patient required a third intervention, and he had significant loss of disc height and advanced solitary DDD at the L5-S1 level, Dr. Vasan recommended fusion of the segment. Ponte osteotomies were performed at L5-S1 to allow for greater lordosis correction. A foraminotomy was performed at L4-L5 and a facetectomy at L5-S1 to decompress the L5 nerve root both above and below. To create the best fusion bed possible, a bi-portal discectomy was performed.

To maximize interbody stability in this very active patient, Dr. Vasan performed a bi-lateral PLIF, implanting two 17mm-wide, endplate-conforming TiHawk11 implants to create the largest footprint possible. Since the patient was in normal sagittal balance with all other lumbar levels healthy, targeted deformity correction was not required at L5-S1.

The TiHawk system provided Dr. Vasan with intraoperative implant selection flexibility to give the patient the largest footprint possible based upon the neural and bony anatomy at the level. He had the option to choose between two insertion profiles: 9mm or 11mm wide. The patient’s large Kambin’s triangles facilitated insertion of the wider implant that expands from 11mm to 17mm.


The patient reported a marked reduction in back and leg pain in the immediate post-operative period.

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