On physical examination, hypoesthesia was noted in the L5 dermatome bilaterally. The pinprick sensation was decreased in the L-5 sellectchem dermatome and no motor weakness was detected. The deep tendon reflexes were reduced in the left leg and the straight leg-raising sign was negative. Electromyography examination suggested left L-4 and L-5 radiculopathy. Sagittal MR imaging revealed L4-L5 and L5-S1 discopathy and disc herniation, spinal stenosis, and bilateral foraminal stenosis more marked at the level (Figures 8(a) and 8(b)). Figure 8 Illustrative Case number 9. Radiological studies obtained in a 83-year-old man. Sagittal (a) and axial (b) T2-weighted magnetic resonance images of the lumbar spine, showing narrowing of the spinal canal at L4�C5 and L5-S1 and bilateral foraminal … 3.1.2.
Surgical Procedure A right percutaneous arthrodesis with augmented fenestrated pedicle screws in L4-L5 and S1 combined with a contralateral minimal access total L4-5 and L5-S1 facetectomy and TLIF (with interbody cages filled with a mixed allograft and autologous bone marrow) was performed. A recalibration of the canal was performed through the unilateral miniaccess. A minimal asymptomatic paravertebral lateral extravasation of PMMA was noted. 3.1.3. Postoperative Course The patient’s case was reviewed at 12 months postoperatively. Control lumbar spine radiography confirmed the stability of the fusion, as well as the absence of hardware failure (Figures 8(c) and 8(d)). Clinically, the patient noted a significant reduction of the preoperative pain and a walking perimeter objectively increased.
4. Discussion In recent years, minimally invasive surgical techniques to perform spinal stabilization have gained in popularity due to the demonstration of reduced perioperative muscular damage, blood loss, postoperative pain, and rehabilitation time [19�C24]. Reported as safe and effective in the normal population, those techniques have been referred to the aging population with poor bone quality as a contraindication. Indeed, in elderly patients, the conventional open procedure of arthrodesis using posterior pedicle screws are considered as a challenge. Many complications have been reported and correlated with decreasing bone mineral density [11�C13]. Carreon et al. [25] reported after lumbar arthrodesis that at least 1 major complication occurred in 21% and at least 1 minor complication in 70% of elderly patients.
Okuda et al. [26] reported 16% of postoperative complications in elderly patients after PLIF with pedicle screw placement. Dong et al. [27] was the first to analyse the potential interest of a mini-open TLIF approach for single-level instrumentation degenerative spondylolisthesis and stenosis with instability in elderly adults and reported a good Anacetrapib clinical and radiological outcome associated with a low rate (7.4%) of minor complications.