Anamnesi del paziente

The patient presented with girdle-like lumbar pain irradiante al gluteo destro e alla parte dorsale della gamba sinistra fino al tallone. Dolori crampiformi si verificavano durante il movimento. Con qualsiasi cambiamento di posizione, 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, per la quale è stata eseguita una nucleotomia a radiofrequenza nel 2013. Dopo l'intervento, la condizione è migliorata leggermente, ma il dolore irradiante durante il movimento si è sviluppato come conseguenza postoperatoria. Il successivo trattamento conservativo (blocchi radicolari, iniezioni, fisioterapia) non ha fornito miglioramento.did not provide lasting improvement.

Diagnosi

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

Rapporto operatorio — Metodo MIBRAR®

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 from Vena cephalica — separation of autologous CGF concentrate enriched with platelets, growth factors, and anti-inflammatory factors
Liposuction — harvesting of subcutaneous adipose tissue and separation of Lipogems® concentrate with regenerative substance concentration 1000 times greater than bone marrow
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 into foraminal openings with dilation and lavage of neuroforamina L4/L5 and L5/S1 bilaterally

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

Una serie di 15 immagini documenta la ricostruzione per stadi dei dischi L4/L5 e L5/S1: dalla condizione preoperatoria attraverso i risultati intraoperatori fino al follow-up a 18 mesi. 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. Immediatamente dopo 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.

Risultati del trattamento

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. Disc height and shape restored, retrolisthesis resolved, sagittal balance normalized. Regeneration continued after the procedure.

A lungo termine

Symptoms did not recur. The patient has no limitations in daily life, actively participates in sports. Spinal fusion and disc replacement were not required.