N.T.N.S 66-year-old female suffering serious spondylolisthesis associated low back pain, successfully underwent fusion surgery performed by Dr. Huynh Hong Chau, Neuro-surgeon using spinal navigation and advances in spine imaging combined.

January 9, 2019, patient N.T.N.S, got admitted in chronic lower back pain, associated with numbness or weakness with activities such as bending and lifting, and often eases when lying down. A fusion surgery for spondylolisthesis was appointed by CIH Neurosurgeons which considered the only option for this particular patient because previous non-surgical treatments (such as pain relief medications and physical therapies) are no longer keeping the pain at a manageable level, but increasing the slippage areas and sciatica which may be aggravated by standing, walking, bending, straining and coughing.

Dr. Huynh Hong Chau shared detailing this life-saving process, starting with diagnosing the problem and consulting the patient: "The CT and MRI scans for đêcting obtained with the patient lying flat, however sometimes a slip may only be obvious when standing or bending forwards. This is why we obtain flexion, extension and standing X-rays, and occasionally a CT myelogram. Results on  X-rays and CT scans showed a slip (grade 2) in the spinal vertebrae at L3-4 and L5-S1 which caused the pain.  As one bone slips forward on the other, a narrowing of the intervertebral foramen may also occur (foraminal stenosis). Severe nerve compression can therefore occur with pain, numbness and weakness in the legs. Sometimes loss of control of the bladder and/or bowels can occur due to pressure on the nerves going to these important structures."

Figure shows the spondylolisthesis (forward slippage of L5 on S1)

At this grade, bone graft, or a bone graft substitute, is placed between vertebrae in order to fuse them and create a stronger and more stable spine. The bone graft is inserted into the disc space from the side (so the nerve roots being moved less during the procedure and may reduce the risk of scarring or damaging the nerve roots.) In addition, spinal instrumentation such as screws and rods are used to hold the spine in position and help promote successful fusion.” Dr. Huynh Hong Chau added.

Dr. Chau continued “Today there is a Minimally Invasive Surgery (MIS) technique that is proving to be an effective alternative to "open" fusion surgery. In a minimally invasive TLIF, the surgeon inserts a small tube through the skin until it "rests" on the spine. Using special surgical instruments the surgeon then does the entire Transforaminal Lumbar Interbody Fusion (TLIF) procedure through the tube by doing a Decompression (taking pressure off the nerves) and spinal fusion to secure the vertebrae together.Working through the small tube, instead of a larger "open" incision, greatly reduces the amount of muscle and tissue that is cut or retracted. Blood loss is dramatically reduced. These minimally invasive benefits also lead to shorter hospital stays and quicker patient recovery times."

We also discuss with Dr. Huynh Hong Chau on the literature and the advantages of computer-aided navigation techniques over fluoroscopic imaging methods:"Conventional pedicle screw placement focused on the anatomical landmarks, entry point, and insertion angle which must be performed flawlessly by experienced surgeons. With the development of Minimally Invasive Surgery (MIS) technique using intraoperative computed tomography image-guided navigation, operations with the assistance of navigation systems result in a higher accuracy of pedicle screw placement and less risk of neurovascular injuries than operations without navigation systems.”


Kick® Spine navigation platform

Computed tomography (CT) of the lumbar spine was performed with selectively positioned 2-mm-thick axial cross sections to examine each disk level from the top of the neural foramen to the pedicle of the next caudad vertebra. We attempted to determine the presence of spondylosis, spondylolisthesis, or other pathology leading to compression of spinal nerve roots, spinal nerves, or thecal sac at each level.

Real-time spinal imaging using 3D-based navigation in MIS spinal surgery

Talking to the patient, she shared: “I hurt my back once when I was little; since then I have been suffering from severe pain when moving and this restricted my recreational activities as well as mobility. I’ve failed all possible non-surgical treatments include physical therapy, heat/ice, anti-inflammatory or neurologic-acting medication, bracing, or spinal injections before surgery. For several months, I have been suffering from acute pain in my lower back (pain goes thru buttocks down back of my legs) to the point that pain relief medication was no longer effective but surgery.”

Dr Huynh Hong Chau and his patient doing very well in her recovering

For patient S. in particular and those suffering from high-grade spondylolisthesis. a fusion is necessary to adequately deal with the mechanical issues of instability in spondylolisthesis. without surgery being promptly addressed, more severe complications can be triggered leading to experience pain on standing or walking, slipping vertebrae from grade I to grade II, grade III and grade IV, severe bowel or bladder dysfunction, and significant weakness.


Our powerful surgical team

According to Dr. Huynh Hong Chau, "minimally invasive surgery with assistance of computer-aided navigation techniques, on average, patients have a faster recovery, and return to normal activity and work faster. Rest followed by a gradual return to exercise can help the back heal in some cases. Prolonged strict bed rest, however, is generally not recommended. Every day, patients should go outside and get some fresh air. Weight-bearing exercises such as walking or jogging in early morning sunshine does wonders for this. Consume three to five serves of calcium-rich foods daily with much less: saltiness, sweetness, fattiness."

City International Hospital is one of the first few hospitals applied high-tech surgical technique for a lower occupational radiation exposure for operative room personnel, reduced need for postoperative imaging, and decreased revision rates. Most importantly, we demonstrate that use of intraoperative cone beam CT image-guided navigation has been reported to increase accuracy. It lights up new hopes and Quality of Life Improves With Minimally Invasive Surgery for patients suffering from painful spondylolisthesis.

Dr. Huynh Hong Chau is the most senior surgeon, clinical instructor, senior consultant neurosurgeon with 37 years of experience in neurosurgery. He is the medical director of Neurosurgery Division at HCMC University Medical Center, and currently practices in City International Hospital, Vietnam. His various areas of expertise include: combined Neurosurgery and spine surgery , neurovascular diseases of the brain, carotid artery disease, skull base surgery for complex intracranial tumors, peripheral nerves surgery, trigeminal neuralgia, and hydrocephalus.

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