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spinemonitor: Neck & Back Pain eNewsletter from SpineUniverse.com
spineuniverse.com/professional October 29, 2008

This edition of spinemonitor features two original cases.  Timothy R. Kuklo, MD, JD presents an interesting case of degenerative scoliosis in an elderly woman.  John J. Carbone, MD discusses Dr. Kuklo’s case and the patient’s level of disability.  Larry T. Khoo, MD presents trans-sacral fusion of L5-S1 spondylolisthesis.  Reginald Q. Knight, MD comments on this less invasive surgical option.

Featured Case Study
Significant Back and Leg Pain in a 70-Year-old Female
Photo: Timothy R. Kuklo, MD, JD Case Author:
Timothy R. Kuklo, MD, JD
Associate Professor
Orthopaedic Surgery and Neurological Surgery
Washington University School of Medicine
St. Louis, MO

History
The patient's previous medical history is significant for poliomyelitis and generalized left leg weakness. She experiences increasing inability to stand, walk, or perform activities of daily living, such as cooking secondary to severe back pain and right leg pain. She stated she "can't live like this". She has a several year history of …

Examination
Overall, fair sagittal balance, but she is unable to maintain posture. Her trunk shifts to the right. The neurologic examination is significant for…

Imaging
Left and right standing, as well as posterior photos demonstrate mild sagittal imbalance and right trunk shift. Note: She needs to…

Read Complete Case, Vote for Treatment, and View Outcome

Right trunk shift and coronal imbalance

Fig. 2A - Right trunk shift and coronal imbalance.
Click here for Larger Images

How Would You Treat this Patient?
Sponsored Technology Case Study
Trans-sacral Fusion of Spondylolisthesis at L5-S1
Larry T. Khoo, MD Case Author:
Larry T. Khoo, MD
CoDirector
UCLA Comprehensive Spine Center
Los Angeles, CA
This case sponsored by: Pioneer Surgical Technology

History
The patient is a 49-year-old-male mechanic, who presents with a 1-year history of axial low back pain and primarily right leg sciatica. He describes his pain as 50% back pain and 50% leg pain.   His back pain is exacerbated by…

Examination
The patient is a healthy 5'11" male who weighs 205 pounds. Vital signs are normal. His musculoskeletal examination was significant for left trunk tilt, antalgic gait, right leg limp, visible listhetic crease in his trunk near L5-S1, as well as pain on deep pressure in that region. There is no visible atrophy of…

Images
AP and lateral x-rays revealed a mobile spondylolisthesis at L5-S1, which reduced from 30% to 15% between flexion and extension. There was a significant loss of…

Read Complete Case, Vote for Treatment, and View Outcome

Mobile spondylolisthesis at L5-S1

Fig. 2A - Mobile spondylolisthesis at L5-S1.
Click here for Larger Images

How Would You Treat this Patient?

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Past Spine Cases:
Below is a listing of previous spine case studies. Feel free to browse and vote for treatment options for each case.
S1 Failure in an Elderly Female
By Christopher I. Shaffrey, MD

Debilitating Back Pain with Neurogenic Claudication
By Neel Anand, MD, Mch Orth

Progressive Back Pain in a 26-Year-old Male
By Jeffrey C. Wang, MD

Cervical and Bilateral Arm Pain
By Randy F. Davis, MD

Adult Scoliosis: Progressive Lower Extremity Radicular Pain
By Christopher I. Shaffrey, MD

Cervical DDD with Myelopathy?
By Richard G. Fessler, MD, PhD

Increasing Back and Leg Pain, Quadricep Weakness
By Timothy R. Kuklo, MD, JD

View All Case Studies

Update your Practice

Featured CME Opportunity - January 17-20, 2009
18th Annual Dr. Tom Lowe Spine Symposium
The Surgical Management of Spinal Disorders

Maximum 14.25 AMA PRA Category 1 Credit(s)

The Pines Lodge
Beaver Creek, CO


Gather with leading spine surgeons for in-depth case discussions and debates on spine surgery challenges and complications. This year's topics include arthroplasty, osteoporosis, and new options for the scoliotic spine. Collegial and interactive atmosphere in exceptional ski-in, ski-out location.


Download Course Brochure and Register Today

The Pines Lodge, Beaver Creek, CO

Chairmen:
  • Keith H. Bridwell, MD
  • Richard G. Fessler, MD, PhD
  • Christopher I. Shaffrey, MD

Featured Online CME Opportunity
Pedicle Screw Fixation: Osteoporotic Bone

This online continuing education program is designed to provide orthopaedic and neurological spine surgeons with a review of pedicle anatomy, bone remodeling, and osteoporosis. Also presented are the characteristics of pedicle screws, use indications and contraindications, as well as surgical planning and intra-operative guidance. The surgical challenges and complications, including those related to implantation into osteoporotic bone are further explored and fenestrated screws are presented as a viable solution.

Medical Education Resources designates this educational activity for a maximum of 1.0 AMA PRA Category 1 credit(s)™.

Begin Program

Online CME: Pedicle Screw Fixation: Osteoporotic Bone

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