Anamnese

The patient presented with girdle-like lumbar pain mit Ausstrahlung in das rechte Gesäß und den dorsalen Teil des linken Beins bis zur Ferse. Krampfartige Schmerzen traten bei Bewegung auf. Bei jeder Änderung der Körperposition, sitting or standing, the patient assumed a forced protective posture. Visual examination revealed lumbar spine curvature and pelvic misalignment.

The patient had a history of L5/S1 herniation, wofür 2013 eine Hochfrequenz-Nukleotomie durchgeführt wurde. Nach der Operation verbesserte sich der Zustand etwas, jedoch entwickelten sich ausstrahlende Schmerzen bei Bewegung als postoperative Folge. Die anschließende konservative Behandlung brachte keine Besserung.did not provide lasting improvement.

Diagnose

  • Status post radiofrequency nucleotomy L5/S1 (2013) — with postoperative complications
  • Hypolordosis — disruption of the physiological lumbar curve
  • Degenerative changes and disc height reduction L4/L5
  • Pseudoretrolisthesis of L4 — posterior vertebral body displacement
  • Complete L5/S1 disc wear with bone-to-bone vertebral contact — absolute degeneration
  • Pseudoretrolisthesis of L5
  • Bilateral spondylarthrosis L4/L5 and L5/S1 — activated facet joint arthrosis
  • Activated osteochondrosis L4/L5 and L5/S1
  • Bilateral neuroforaminal stenosis L4/L5 and L5/S1
  • Lumbosacral destabilization
  • Spinal sagittal balance disruption

Operationsbericht — MIBRAR®-Methode

Procedure performed on 02.05.2016 at the MIBRAR clinic (Munich) under Prof. Dr. med. Arsen Babayan. Outpatient, under local anesthesia, with fluoroscopic guidance.

  • Venous blood collection aus der Vena cephalica — Separation von autologem CGF-Konzentrat, angereichert mit Thrombozyten, Wachstumsfaktoren und entzündungshemmenden Faktoren
  • Liposuction — harvesting of subcutaneous adipose tissue and separation of Lipogems® concentrate mit einer 1000-fach höheren Konzentration regenerativer Substanzen als im Knochenmark
  • Intradiscal transplantation under fluoroscopic guidance into L4/L5 and L5/S1 discs — disc height, volume, and shape reconstruction
  • Bilateral intra-articular transplantation into L4/L5, L5/S1 facet joints — joint space widening and joint reconstruction
  • Peridural application in die Foraminaöffnungen mit Dilatation und Lavage der Neuroforamina L4/L5 und L5/S1 bilateral

X-ray and MRI — Before, During, and 18 Months After MIBRAR®

Eine Serie von 15 Aufnahmen dokumentiert die schrittweise Rekonstruktion der Bandscheiben L4/L5 und L5/S1: vom präoperativen Zustand über intraoperative Ergebnisse bis zur 18-Monats-Kontrolle. Final images show full reconstruction of both segments and sagittal balance restoration.

Pre-operative lumbar MRI: L4/L5 degeneration, L5/S1 wear, osteochondrosis
Pre-operative MRI (sagittal plane, 3 slices): Degenerative deformation L4/L5, post-surgical L5/S1 wear with bone-to-bone contact, osteochondrosis. Sagittal balance disruption.
Lumbar MRI: coronal plane — L4/L5, L5/S1 disc degeneration, scoliosis
Pre-operative MRI (coronal plane): Degenerative deformation of L4/L5 and L5/S1 discs, bony changes, right-sided scoliosis.
Lumbar MRI: axial plane — L4/L5, L5/S1 facet joint arthrosis
Pre-operative MRI (axial plane): L4/L5 and L5/S1 facet joint arthrosis — bilateral articular surface degeneration.
X-ray: intradiscal MIBRAR® transplantation L5/S1 — sagittal and frontal views
Intraoperative X-ray (sagittal): Before surgery — retrolisthesis, disc wear. Sofort danach MIBRAR® — disc height increase, retrolisthesis resolved, both segments reconstructed.
X-ray: frontal view — L4/L5, L5/S1 disc reconstruction during MIBRAR® procedure
Intraoperative X-ray (frontal): Left — nearly absent L5/S1 interdisc space before surgery. Right — space increase, volume restoration of both segments.
18-month follow-up X-ray: before and after comparison — full disc reconstruction
18-month follow-up (sagittal): Comparison with pre-operative condition — full reconstruction of height and shape of both discs, retrolisthesis resolved, spinal sagittal balance restored.
18-month follow-up X-ray: frontal view — L4/L5, L5/S1 segment reconstruction
18-month follow-up (frontal): Further increase in interdisc space and reconstruction of both segments compared to intraoperative result — confirmation of ongoing regeneration.

Behandlungsergebnisse

After 1 week
Complete absence of complaints and all previously described symptoms — girdle-like pain, leg radiation, cramping pain during movement. Pain medication discontinued.
After 18 months
Follow-up X-ray (10.11.2017) confirmed: full reconstruction of both L4/L5 and L5/S1 segments. Bandscheibenhöhe und -form wiederhergestellt, Retrolisthese behoben, sagittale Balance normalisiert. Die Regeneration setzte sich nach dem Eingriff fort.
Langzeitverlauf
Symptoms did not recur. The patient has no limitations in daily life, treibt aktiv Sport. Wirbelsäulenversteifung und Bandscheibenersatz waren nicht erforderlich.

Weitere klinische Fälle

Lendenwirbelsäule
Disc Degeneration + Spondylolisthesis L4
Female, 47 years. Two MIBRAR® procedures — full reconstruction.
Lendenwirbelsäule
Scoliosis + Spondylolisthesis + 14 mm Herniation
Female, 54 years. Scoliosis and paraparesis resolved in 2 weeks.
Cervical spine
Stenosis C4–C6 + C5/C6 Herniation 5.8 mm
Female, 38 years. Herniation no longer detectable after MIBRAR®.
Kniegelenk
Meniscus Tear — Regeneration in 4 Weeks
Male, 56 years. Full recovery without arthroscopy.

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