It was reported that on (b)(6) 2007 ,the patient underwent laminectomy l2-3, l3-4 with laminectomy, foraminectomy, inferior facetectomy l4-5 and l5-s1.Transforaminal discectomy l4-5 and l5-s1.Interbody cage insertion (cage with bone morphogenic protein) l4-5 and l5-s1.Posterior lateral interbody fusion with local bone graft l4-5, l5-s1.Posterior lateral spinal fusion with legacy segmental instrumentation l1 to s1.Implantation of ebi bone growth stimulator.Preoperative diagnosis: lumbar disc herniation with spinal stenosis, l4-5, l5-s1, lesser amounts at l3-4.Lumbar scoliosis.Per-op notes: decompression was started distally and moving proximally the laminectomy, foraminotomy and inferior facetectomy at l5-s1, followed by l4-5.There was definitely some ligamentum flavum hypertrophy.A transforaminal discectomy was carried out at l4-5 and l5-s1 with curets, rongeurs, and disc shavers.Each pedicle was tapped and probed and no disruptions were found.Decortication of the transverse processes and the outer portion of the facet joints, as well as sacral ala, were completed with a but bilaterally.The legacy transpedicular screws were then placed at each level and triggered emg stimulation of all screws was normal.At the l4-5 and l5-s1 cage filler with bone morphogenic protein was inserted into the interbody space.The posterior lateral interbody fusion was completed using local bone graft at both l4-5 and l5-s1.This was followed by placement of bone grafting material in the posterior lateral gutters, including local bone graft, bmp and bone graft.After the general posterior lateral fusion from l1 to sacrum, intraoperative x-ray showed excellent position of all implants.
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