Anamnese

For the past eight years, klagte die Patientin über Schmerzen in der Lendenwirbelsäule beim Gehen und Drehen sowie beim Aufstehen aus der sitzenden Position. Die Schmerzen strahlten häufig in die Beine aus, especially to the left leg, with a girdle-like character.

The patient constantly experienced dull lumbar pain und Taubheit an der Außenseite beider Beine, besonders ausgeprägt links. Jahrelange konservative Behandlung erzielte keine dauerhafte Besserung. The empfohlene Stabilisierungsoperation mit Wirbelsäulenversteifung wurde von der Patientin abgelehnt.

Diagnose

  • 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) — angereichert mit Thrombozyten, Wachstumsfaktoren und entzündungshemmenden Faktoren (aus venösem Blut)
  • 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)

Wiederholte intradiskale und intraartikuläre Transplantation nach demselben Protokoll zur Verstärkung und Konsolidierung des regenerativen Effekts:

  • 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

A series of X-rays in sagittal and frontal views documents the staged disc reconstruction: präoperativ → Zwischenergebnis → intraoperatives Endergebnis → 10-Wochen-Kontrolle → 14-Monats-Kontrolle → 3-Monats-Kontrolle nach dem zweiten Eingriff.

X-ray: intradiscal MIBRAR® transplantation L5/S1 — before and after, sagittal view
L5/S1 — sagittal view: Links — Einführung der Spinalsonde vor der Implantation. Rechts — nach Transplantation: deutliche Zunahme der L5/S1-Bandscheibenhöhe unmittelbar nach dem Eingriff.
X-ray: 10-week and 14-Monats-Kontrolle — L5/S1 disc height increase
L5/S1 — 10-week and 14-Monats-Kontrolle: 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: Sondeneinführung vor der Implantation. Rechts — nach Transplantation: Zunahme des Zwischenwirbelraums und Wiederherstellung der Bandscheibenform.
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.

Behandlungsergebnisse

After 1st procedure
Sofort danach 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.
Langzeitverlauf
Symptoms did not recur. The patient has no limitations, actively participates in sports. Spinal fusion was not required.

Weitere klinische Fälle

Lendenwirbelsäule
Lumbar Stenosis After Nucleotomy
Female, 43 years. L4/L5, L5/S1 disc reconstruction in 18 months.
Lendenwirbelsäule
Scoliosis + Spondylolisthesis + 14 mm Herniation
Female, 54 years. Scoliosis and paraparesis resolved in 2 weeks.
Brustwirbelsäule
Fracture Th8–Th9 + Stenosis + Paraparesis
Male, 50 years. Symptom resolution within 1 week.
Kniegelenk
Meniscus Tear — Regeneration in 4 Weeks
Male, 56 years. Full recovery without arthroscopy.

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