TiBow Case Study
Clinical Case Study
TiBOW – Laminectomy from L3-5
53 year old patient with years of worsening sciatica and neurogenic claudications. On physical exam he demonstrated bilateral L4/5 ankle dorsiflexion strength and diminished sensation in an L5 distribution. Preop CT demonstrated severe facet arthropathy (Figure 1). Preop MRI demonstrated severe lateral recess and foraminal stenosis, with grade 1 spondylolisthesis at L3-4 and L4-5 (Figure 4 & 5). Having failed conservative management, I recommended L3-5 laminectomy and fusion.
After performing a laminectomy from L3-5, TiBow interbody devices were inserted in standard TLIF trajectory at L3-4 and L4-5 (Figure 7), followed by modular pedicle screw instrumentation (Figure 11). Surgery was without complication. Intraoperative 3D imaging (Zhiem) demonstrated good expansion of the TiBow cages. The patient was discharged on post-op day 4 after an uneventful hospital course. In short term outpatient follow-up he noted resolution of his sciatica. Post-op x-rays demonstrated good interbody position without subsidence (Figure 12).
• L3-5 Laminectomy with Fusion
• EBL – 300cc
• Cut to close time – 3.5 Hours