Hasta Öyküsü

The patient presented with girdle-like lumbar pain sağ kalçaya ve sol bacağın dorsal kısmına topuğa kadar yayılan. Hareket sırasında kramp şeklinde ağrı oluşuyordu. Vücut pozisyonunda herhangi bir değişiklikte, 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, bunun için 2013'te radyofrekans nükleotomi yapıldı. Ameliyat sonrası durum biraz iyileşti, ancak hareket sırasında yayılan ağrı postoperatif sonuç olarak gelişti. Sonraki konservatif tedavi (sinir kökü blokları, enjeksiyonlar, fizyoterapi) iyileşme sağlamadı.did not provide lasting improvement.

Tanı

  • 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

Ameliyat Raporu — MIBRAR® Yöntemi

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®

15 görüntüden oluşan bir seri, L4/L5 ve L5/S1 disklerinin aşamalı rekonstrüksiyonunu belgeliyor: preoperatif durumdan intraoperatif sonuçlara ve 18 aylık takibe kadar. 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. Hemen sonra 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.

Tedavi Sonuçları

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

Diğer Klinik Vakalar

Bel omurgası
Disc Degeneration + Spondylolisthesis L4
Female, 47 years. Two MIBRAR® procedures — full reconstruction.
Bel omurgası
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®.
Diz eklemi
Meniscus Tear — Regeneration in 4 Weeks
Male, 56 years. Full recovery without arthroscopy.

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