التاريخ المرضي

For the past eight years, اشتكت المريضة من ألم في العمود الفقري القطني أثناء المشي والدوران وعند الوقوف من وضع الجلوس. كان الألم يمتد بشكل متكرر إلى الساقين، especially to the left leg, with a girdle-like character.

The patient constantly experienced dull lumbar pain وخدر في الجانب الخارجي من كلا الساقين، بارز بشكل خاص في اليسرى. سنوات من العلاج التحفظي لم تحقق تحسناً دائماً. رفضت المريضة جراحة التثبيت مع الدمج الفقري الموصى بها.

التشخيص

Degeneration and circumferential disc protrusion L3/L4
Deformative degeneration of L4/L5, L5/S1 discs — pronounced destruction with shape alteration
Spondylolisthesis with L4 vertebral ventralization — anterior vertebral body displacement
Circumferential stenosing central-lateral protrusion L4/L5 — caused by spondylolisthesis
Absolute foraminal stenosis L5/S1 — complete nerve canal closure
Destabilization of L4/L5, L5/S1 segments — loss of spinal column stability
Bilateral facet joint arthrosis L3/L4, L4/L5, L5/S1 — degeneration at three levels

Two-Stage Treatment — MIBRAR® Method

First Procedure — 29.02.2016

Intradiscal and intra-articular transplantation of autologous concentrates into L4/L5, L5/S1 segments:

CGF (Concentrated Growth Factors) — enriched with platelets, growth factors, and anti-inflammatory factors (from venous blood)
Lipogems® (microfragmented adipose tissue) — with high concentration of regenerative substances (from subcutaneous adipose tissue)
Injection sites: intradiscally into L4/L5 and L5/S1, intra-articularly into facet joints at both levels

Second Procedure — 20.04.2017 (after 14 months)

زراعة متكررة داخل القرص وداخل المفصل بنفس البروتوكول لتعزيز وتوطيد التأثير التجديدي:

Repeat CGF and Lipogems® implantation into L4/L5, L5/S1 discs
Goal: further disc height increase, structural reinforcement, and full repositioning of displaced L4 vertebra

Radiological Follow-up — Reconstruction Stages

سلسلة من الأشعة السينية في المنظرين السهمي والأمامي توثق إعادة بناء القرص المرحلية: قبل العملية → intermediate result → final intraoperative result → 10-week follow-up → 14-month follow-up → 3-month follow-up after the second procedure.

X-ray: intradiscal MIBRAR® transplantation L5/S1 — before and after, sagittal view

L5/S1 — sagittal view: يسار — إدخال المسبار الشوكي قبل الزراعة. يمين — بعد الزراعة: زيادة واضحة في ارتفاع قرص L5/S1 فوراً بعد الإجراء.

X-ray: 10-week and 14-month follow-up — L5/S1 disc height increase

L5/S1 — 10-week and 14-month follow-up: Progressive disc height increase continuing after the procedure. At 14-month scan — further restoration.

X-ray: second MIBRAR® procedure L5/S1 — repeat implantation, sagittal view

L5/S1 — second procedure (20.04.2017): Repeat CGF and Lipogems® implantation to consolidate results and further increase disc height.

X-ray: L4/L5 frontal view — interdisc space increase after MIBRAR®

L4/L5 — frontal view: Probe insertion before implantation. Right — after transplantation: interdisc space increase and disc shape restoration.

X-ray: L4/L5 follow-up — disc height restoration, progressive regeneration

L4/L5 — follow-up: Progressive disc shape restoration at 4 and 14 months. Height reduction stopped and reverse process initiated.

X-ray: L4/L5 sagittal — L4 ventrolisthesis before and resolution after MIBRAR®

L4/L5 — sagittal view, ventrolisthesis resolution: Before surgery — disc height reduction and L4 ventral displacement. After — height increase, partial then full vertebral repositioning to anatomically correct position.

X-ray: final follow-up 3 months after second procedure — full reconstruction L4/L5, L5/S1

Final follow-up (14.07.2017): Complete restoration of L4/L5 and L5/S1 disc height and shape. Full return of L4 vertebra to anatomically correct position — no signs of ventrolisthesis.

X-ray: before surgery and 3-month comparison — sagittal and frontal views

Before and after comparison (sagittal + frontal): Full reconstruction of both segments — disc height restoration, L4 vertebral repositioning, sagittal balance normalization. Result of ongoing post-operative regeneration.

نتائج العلاج

After 1st procedure

فوراً بعد the first intervention, radiating pain to the left leg disappeared. Numbness symptoms ceased within 3 days. Lumbar pain significantly decreased within a week. Complaints reduced by 80%.

After 10 weeks

Follow-up X-ray confirmed L4/L5 and L5/S1 disc height increase. Beginning of post-operative regeneration.

After 14 months

X-ray before second procedure: further disc height increase. L4 vertebral ventralization — no significant changes. Decision made for repeat procedure for full repositioning.

After 2nd procedure

One month after the second procedure — complete absence of complaints. For the first time in 8 years, the patient is pain-free.

Follow-up 14.07.2017

Final X-ray (3 months after 2nd procedure): full reconstruction of both segments — disc height and shape restoration, full L4 repositioning, sagittal balance normalization.

على المدى الطويل

Symptoms did not recur. The patient has no limitations, actively participates in sports. Spinal fusion was not required.