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this is doctor corenman and we’re going to
talk about a transforaminal lumbar interbody fusion using minimally invasive micro surgical technique stealth and the O Arm this is a typical picture of a very
degenerative L5 S1 disc the disc has collapsed and you can see
black vacuum phenomenon this is the MRI finding where you can
see the lowest disc is much collapsed compared to the
ones above with bone signal changes indicating
stress fracturing this is a discogram where the two
discs above the degenerative disk obviously normal with a cotton ball
appearance and the L5 S1 disc is quite degenerative this is the technique of the pedicle screw insertion we start first by putting a small frame on the spinous
process which you can see protruding out of the blue sheets there we cover it with a clear sheet in order to protect
the sterility of the field this device is an O Arm it’s an intro
operative CT scanner and this device can lend us images not only front to
back and side to side but top to down which makes surgery much safer and much easier for insertion of the screws we’re going to watch how this CT works
the light on top comes on and you’ll see this image spin around and this is the actual CT scan and how
long it takes this CT is one-third the typical
exposure of a standard CT performed in a
hospital here are the tools that we use in order
to identify the levels the incisision has alread been made that device that is protruding
out is attached to the spinous process the device I am and holding identifies the
level that we are at after identify where the screw is going to be inserted I use a small burr to create a starting hole once that starting holes is created then i use a tool called a pedicle finder or pedicle to find the pedicle and this is done under direct visualization
you’ll see here that this device that i have has these balls
attached and these balls reflect off of a frame
and is very similar to a GPS device you can actually insert the device into the pedicle without any
problems because you’re looking at the pedicle both a front and side and a top-down
view you’ll see this in a second here we will switch to the screen and you’ll see
exactly what i’m staring at so there is the vertebra the blue device is the all itself and you can see that i can easily find my way down the pedicle by the feel of the device while i’m
actually physically inserting it and by the visualization that i see both on the front
side top and middle views once this device is in we have a track the screw is going to
follow we remove the device and it should be in there pretty rigidly
and then we want to tap the hole just like you would tap a wood screw and so we take the device out that finds the
pedicle and this is the tap that we use to tap the hole after we’re finished with the tap we will then insert the screw itself that’s attached to the same type of
tracking device that we used to find the hole in the first
place and we can follow the screw down into the pedicle so here the tap is being removed here the screw is now being inserted
into the tapped hole and then once we visualize its flight
planned so-to-speak the screw is inserted and it should be inserted with some good
force because the pedicle should be a strong pedicle and hold the screw
well these are the screws that are going to
hold a vertebra in place while the fusion is taking place once the screw device is removed then we insert the other three screws but here is what i’m visualizing when
the screw is being inserted you can literally watch the screw marching down
the pedicle and avoiding all of the sensitive
structures such as the nerves and the vascular supply this is one screw insertion and four
screws are inserted at this point in order to be able to complete the surgery once the screws finished being inserted
we can actually save the screw in position then we test the screw we run a little
bit of electricity through the screw and by watching this monitor the technician
the neural monitoring technician can determine whether this screw could be irritating
the nerve root or not and with this device the O Arm and stealth it is almost impossible to have a screw irritating a nerve this is what the final screw insertion
looks like from the front to back view you can see that white metal which is
attached to the spinous process that’s the registration probe we will have a side view here also and you
can see the screws inserted and where they exist in the morphology of the vertebral body
or the sacrum and the bottom screws we complete the rest of the surgery after we perform a second O Arm
scan to confirm that the screw position is appropriate and once these are done then we can
review the CT scan and here’s a good example of the vertebra and the screw positioning where
you will see the screws are nicely placed within the pedicle and
within the confines of the vertebra indicating that there is no screw that’s going to irritate a
vascular structure or a nerve root we have post operative films this is a
front to back view of the TLIF the white arrows point to the solid fusion between the vertebra here is the arrow pointing to the solid
fusion between the body of L5 the sacrum and then this is the CT scan at six
months indicating a rock-solid fusion with the
arrow pointing to the solid fusion we will see this is the front to back
view again of the interbody with solid bone formation and this is just at six months it really
gets much greater at a year again the arrows pointing to a solid fusion and this is exactly how we insert pedicle screws using the O Arm
thank you

99 thoughts on “L5 S1 Fusion | TLIF Back Surgery Video | O Arm CT| Vail Colorado

  1. I use the O-arm at work all the time! It is a great tool in surgery! It is amazing how it virtually shows the screws and other hardware in place in the spine.

  2. Just received a fusion surgery to my l5-s1, I had it done this Tuesday around 11:45… And my my expected recovery was supposed to end today, so it really depends on how the surgery goes and the variables of the surgery that occur, I had embedded nerves into so bones that are causing a lot of soreness. So mine is taking longer.

  3. I have gone through a lot with my Back Pain 3 Fusion with Instrumented,Hardware Bone Graft etc etc…Just Last Back Surgery I Went Into The Hospital For One Surgery and I End Up With 3 More Instead Of Only 1 One…. and I Was in The Hospital For Almost 3-4 months and Another 3-4 In Rehabilitation Hospital Center To Gain Some Strengh On My Legs Because I Lost My Sensation, Even Do Its Been Very Hard I Was On a WheelChair for Almost 2 yrs Now I Use Wheel Walker & The Kane But At Least am On My Fe

  4. I am getting this done on April 9th. I had this done in my neck in August of last year and am doing well, but for some reason I am petrified of this one! Mine is going to be done with day surgery as opposed to being in the hospital for any amount of time. What is it like having to get out of bed to go potty?

  5. I was able to return to swimming, yoga, surfing, gradually over time. Zero pain like I had, but the healing process does take a long time. I was told 8 months but it has taken me a 12 months to feel really healthy and strong again. Now 13 months post op and all I feel is a little soreness at times if I sit for too long over a week period.

  6. 6 days in hospital, 8 weeks in a back brace (if they go through the back instead of the stomach), walking for the first 2-3 months only + very gentle swimming – then you're pretty much able to do a little but more every month, then you'll go through a sore period, then you'll try and do a bit more. 12 months to fully recover for me

  7. After a year, you can have the hardware removed, that's of your still on pain. Your doc will have to get your insurance to pay for it, due to still major pain. I had mine removed, but I still have major back pain 🙁

  8. I had a lumbar fusion of my S1 L5 on March 7th of this year (8 weeks ago). A cage was inserted and my spine re aligned. I had a level or grade 3 spondylolisthesis. I came home the same day. There was some nerve damage due to my spinal cord being crushed. Its slightly uncomfortable and slight weakness but overall I feel really good. I was not required to wear any bracepost surgery and started PT a week sfter surgery. The first 3 days hurt like hell but it was manageable with pain meds.

  9. Sir thank you forthe video. would you please suggest as to what should be done when the discs are damaged at L3 -L4, L4-L5 and L5-S1 ? Can fusion be pfeasible and productive? If not what to do? please inform to [email protected]

  10. Dr. Corenman personally answers all questions posted in his forum AskSpineDoc (dot) com. Please move this question there for his response.

  11. in the same boat as you !!! I've been avoiding surfing :(how long before you surfed? they should teach kids at school a heap more about looking after your back,even have streching classes 🙂

  12. Foi me efectuado uma TLIF L4L5S1 em 29.7.2011 em Portugal, e desde então que começou o meu tormento um dos parafusos trespassou o osso em 14mm e só agora e que foi descoberto, estou de momento a fazer 30mg de morfina/dia para as dores….é normal o parafuso trespassar osso , na Alemanha os médicos não querem mexer no parafuso… preciso de ajuda especializada e ja não sei a quem recorrer….alguém me ajuda

  13. Foi me me efectuado TLIF L4L5S1em 29.7.2011 em Portugal, e desde então que começou o meu tormento um dos parafusos (baixo esquerda)trespassou o osso em 14 milímetros,desde a cirurgia que tenho tido dores imensas, e tomo 30 mg de Targin/dia, o que posso fazer ?? Isto é normal acontecer ??Obrigado pela sua ajuda…

  14. That is just crazy seeing that's how they actually do it. I had a 2 level fusion done 9 weeks. Still having original symptoms. Very long recovery

  15. I had this procedure done in South Africa in Sep.1997 with spinal fusion and laminectomy (spelling?) from L3 to S1 – all inclusive! Took a year before I felt comfortable and have never looked back – pun intended. I am now 63 and tour on my motorcycle and live an active retirement.

  16. Thank you for this video and all your other informative videos. My brother has a herniated L5 S1 and goes for a neurosurgeon consult in a few days. Fingers crossed!

  17. hi I am 53 yrs old and go to pain clinic , for L4 l5 s1 I am a workaholic it is getting so bad some times I have to crawl like a dog to bathroom , because I cant stand , will this help

  18. I had this surgery in February 2008. Today is 8/7/14 and I recently learned 1 of my screws is broken. All was healing well & then a false joint developed. Now I must have the surgery redone. This time they're in from the back, placing rods, plates and screws from the original L5S1 up to L2.

  19. +anythingyouwant29, why not try conservative chiropractic care?  It will definitely cost less than this operation.  A friend of mine had this problem at L5-S1 and chiropractic saved him from this surgery. 

  20. had this exact surgery at the Denver VA Dec 2004. woke sitting straight up in bed and in EXTREME pain. then they gave me a PCA (pain med pump) that was used for 24 hrs before they found that it didnt work. Was my 10/10 on pain scale. I had to do it since it was more than 14MM out of allignment. now I have a T level issue and found that Medical marijuana HAS HELPED ME SO MUCH!! Please dont overlook marijuana! i wish i found it 10 years ago! I cried when i saw how much it helped me! its safer too! good luck all! 73

  21. After 2x lower back surgeries, one a complete mis-diagnosis and failure, the other partially successful (they "fixed the road but tore down all the power lines – aka, destroyed the big nerves in my left leg and left foot … a HUGE mess!), I'm now 10+ years downline and facing #3!!  This time, it's the Mayo Clinic Neurosurgery department for me … and I'll have L4-L5 fusion and facet "repair" (not exactly sure of what that is … but my facets are a total disaster).   Also, I'm not sure of the specific techniques that will be utilized in my surgery, or whether it's a "TLIF" exactly.  All I know at this point is that (a) selecting a doctor and hospital that has as their #1 professional "focus" the patient and the problem is THE MOST important aspect of this decision (versus a provider who has as their priority the financial "payoff" .. and BELIEVE ME, after 2x "whacks by hacks", that is a VERY REAL ISSUE today), (b) I believe Mayo Clinic is one of the finest institutions in the world for what I'm dealing with … BTW, and don't hate on me, but if you're a Medicare patient and you go there as a NEW patient seeking help, you will not be treated.  Also, if you go there with "Obamacare" insurance, I'm told they will graciously but firmly .. laugh you out of the building, (c) there are plenty of stories here and on the Internet where fusion surgery has been successful and the person has gone on to live a "normal" life (I'm not sure I know what that is anymore … but I'm hoping and praying I can find out soon).  Good luck to all … and remember: it's the patient & the problem, not the payoff to the provider that counts.

  22. We are a miserable group. And yet brave surgeons still take on the risk of rescuing us from in believable pain. I had 2 surgeries. One as a cleanup mission, and the other as an installation of titanium reinforcements. The difficulties I had were caused by not allowing me adequate time to heal. I was able to walk, using the OLD SCHOOL METHOD, after 3 days. The pain was indescribable, until 72 hours had passed. I am still I a modicum of distress, but what I feel now compares nothing to the agony I was in before my 2 surgeries. While I am indeed eligible for a second surgery and have finished every conceivable screening, trust me when I ask you to you trust your surgeon. The entity that must not be trusted is the one that informs you of your allotted recovery time. Ones recovery is individual and may take years. My recovery took seven years before I can walk unaided and without crutches. Trust you surgeon implicitly, but never trust rehabilitative estimates. And please trust me.

  23. Surgery was completed with no complications. Yes, post op was yet painful however which surgery is not. On my feet after three days. I guess you have to ask yourself, did the M.D. send you a coupon to come in? No you asked for the surgery and knew the possibilities. Enough said.

  24. Interesting.
    The clear sheet does not cover the entire area contaminated by the CT arm.  A larger drape would have.  Why take unnecessary risks?

  25. DO NOT HAVE THIS SURGERY. Some doctors will tell this is your only option and that is absolutely not true. They sell these sham sugeries for the money. My wife had this done 6 years ago and she lives with constant intractable pain and it can't be reversed. Her pain was much more manageable prior to surgery. Once a successful nurse. Now disabled and cannot work.

  26. I just had a 3 level lumbar fusion of S-I-L-4-5. I had to artificial discs implanted instead of rods and screws. They found my L-5 nerve was "frayed", so they had to sew it and then wrap it in something that is suppose to make it grow back. I am at 5 months and I still have no feeling in a third of my left foot to all my toes. I hope I get the feeling back because my balance is off, and I need to use a cane. I can only walk about 20 feet before I have to stop and rest. My left leg will just not continue because it gets so tired.
    I tok to the sea to try water therapy. It did not hurt me, but it also did nothing to strengthen or help the left leg.
    The good news is, my back pain is finally gone.
    I guess we give up something to make another problem go away.
    Artificial discs are the way to go these day. The rods and screws usually fail at some point.

  27. I'm a athlete. Had fusion with hardware. L3-4,4-5.
    Surgery was "fine"…Crippled, out of work 18 months later. 49 yrs old. Became addicted to opiates. Barbaric procedure. DON'T DO IT.

  28. Thank You Doctor for the reality of this type Surgery, this brings more respect to the audience, rather than a chalk board with a total of 4 lines, looking more like an Electrical Code of some kind. I have suffered from low back pain most of my Adult life and this video is not only very Interesting, it says so much about the Doctor you are, in my opinion, a Doctor who really wants to help people live better lives.

  29. I did the TLIF, can't be more grateful 4 days after i was cleared for walking and Sx.act, I stop pain meds after a week, 2 weeks now and I am cleared to drive and recovery keep been less painfull and succesful. Ii wish all of you out there a great and prompt recovery as well.

  30. Yo tu un trasplante de dos discos hace un año y sigo con mucho dolor y ahora me están tratando con epidurales no se si es bueno

  31. I will stick to my meds, it sucks but no screws are going into this ole boys spine,,, barbaric if you ask me. Someday future physicians will look back at this video and shiver.

  32. I've had this surgery twice. It didn't fuse the first time. The second time, they also had to go through my stomach and add a cage around my spine.

  33. Mera b hua hy ye opret L4. L5. S1 with Spain ka jo tklif pehly thi wo ab ni hy jo ab hy wo pehly ni mn penalized b ho gi thi Alhamdulillah opret k bad chlti phirti hun or sb kam b krti hun mery Dr b bht achy hen or jinah hospital Lahore k hen thnx u my Dr team

  34. Mr. Corenman, I m zeeshaan from India and I suffer from disc problem ,l4-l5,l5-s1 bulge… I m suffering from acute pain.. What shd I do, after taking lot of medicine it is back to square one, how far laser surgery will fix my problem…..?
    Regards…

  35. I had a L4-L5-S1 fusion like this on January 30th and I'm still in a lot of pain and can barely walk plus I got a twelve inch scar on my stomach and two six inch scars on either side of my spine it definitely is not worth it

  36. Yoga and healthy diet can cure slipped disk , degenerative disk and all kinds of spinal pains, evidences are available in a Yoga university hospital; www.svyasa.edu.in/arogyadhama

  37. Hye everyone, I am from Malaysia, did an operation for lumbo pelvis, L5-S1,close fractured sacrum ala dennis III, after 4 month operation so far my right leg is still less sensitive. Even the doctor cannot determine the specific time when I can recover to normal. Can anyone tell me what should I eat and the appropriate exercise. Thanks a lot.

  38. I had my lumbar done in 08, I have this squeezen pain around me in to my side of ribs and through my stomachs , I'm not good I'm goen in a circle,no doc will help,nerve pain bad in my lumbar,down my leggs, now up my both sides of my neck ,I pray all the time ,one day hopefully a doc,can help me,I got all disc neck,throcia,lumbar, hernated ,bulgen,nerve,roots,pinched nervers ,I'm a mess, I know u all have pain too ,Prayen for all, God did make the doctors why they won't help,?

  39. Danny Perez due to L5 S1 compression i suffered foot drop .i had back pain for 1week then my right leg foot drop occurred. L5S1 micro discectomy was done after about 1.5 month.. Because of foot drop i unable to walk properly.. Please ans me..
    …is foot drop recoverable?

  40. Having surgery soon. Waiting ON INS approval. TILF on L5/S1 DOCT says I should have great results as I have very bad sciatica. I have been getting shots for last 5 years but no longer get relief form them.

  41. Doc- Do you prefer the T over the A LIF? If so, why? I live in Georgia and I'm a 48 year old diabetic that has just undergone my second discectomy on L5 S1. The disc has re-herniated only three months after surgery #2. I'm very frustrated and getting a bit down on myself. My surgeon prefers the ALIF, but I'm nervous about the vascular risk. Your thoughts please….

  42. I had L5 S1 fusion surgery last November 19 th. but still no twisting,no bending,can not sit too low. left leg pain.review on January 18 th.

  43. Doctor told me that an operation is inevitable. I will rather exercise and do pilate classes. God help me to NEVER have this operation.

  44. I had this procedure 1/10/2019. I'm 3 weeks out, Horrible pain. Still having pain, I am making progress,Not for the weak!!

  45. What the f……. is this a operation or a drilling what the hell is he doing with that Hammer…is that a surgury with screw driver and Hammer

  46. I'm looking at this video… My Doctor is telling me I need this surgery! Are their any other alternatives? Transforaminal Lumbar interbody is and Fusion!!

  47. Respected Sir I'm Sarath Kumar.G 26y from Thamizh Nadu India. I had the TLIF surgery in L4-L5 on 7 Dec 2018 at SRM institute Thamizh Nadu India. They told that I'll be okay within 3 months after surgery but still I'm suffering too much of pain after surgery. Before surgery is better than now. Is there any cure for this?

  48. Hi sir.
    I'm 23 years old.my L5 & S1 disk is herniation. Dr advise operate, please tell me solve my problem without operation

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