An old man surnamed Wang (middle) was performed spinal revision surgery by director Wu Qiming (left), and he was able to move normally with a smile on his face when he came back for the consultation.

(Photo by reporter Chen Jianzhi)

[Reporter Chen Jianzhi/Taichung Report] 86-year-old Mr. Wang suffered unbearable numbness and pain in his lower back and lower limbs due to lumbar nerve compression. He underwent lumbar spine surgery last year, but due to severe osteoporosis, the vertebral arch nails came loose not long after. I was in so much pain that I went to see a doctor again, and decided to have a spinal revision surgery again, and put in a new osteoporotic vertebral arch screw, and used bone cement to strengthen the stability of the screw. The dura mater was broken, and then knocked forward again to the correct position and the screws were locked, so that the old man finally no longer had pain. The doctor reminded the public to prevent osteoporosis in order to avoid fractures.

Wu Qiming, director of orthopedics at Dali Ren'ai Hospital, said that when the patient arrived at the hospital, he heard him crying out of pain outside the clinic. After examination, it was found that the patient had undergone decompression and fusion surgery on the third to fifth lumbar vertebrae last year due to lumbar nerve compression. However, the vertebral body of the third lumbar vertebrae has collapsed and part of the bone has been lost, causing the pedicle screw to loosen and penetrate into the body of the second lumbar vertebrae, and the intervertebral disc between the third and second lumbar vertebrae has also been damaged and herniated, resulting in narrowing of the spinal cavity. The shims of the fourth to fifth lumbar vertebrae also slide out backwards and press on the nerve roots.

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Wu Qiming said that the patient's symptoms were like two loose flagpoles stuck in his back. The vertebral body collapsed due to the constant shaking, so he was in pain. If he wanted to completely solve this problem, he had to undergo another spinal revision operation However, considering that the patient is 86 years old, has poor cardiopulmonary function, and suffers from severe osteoporosis, the operation risk is high, but the patient and his family members decided to undergo the operation, so a series of physical examinations were arranged to determine the operation process.

The patient underwent lumbar decompression and fusion surgery, but the third lumbar vertebral body had collapsed, and the lumbar screw was loose and penetrated into the second lumbar vertebral body (red arrow), and the shims of the fourth to fifth lumbar vertebrae also slid out and pressed to the nerve root (yellow arrow).

(Photo by reporter Chen Jianzhi)

Wu Qiming said that during the operation, all the screws were pulled out, and new osteoporotic vertebral arch screws were re-inserted outside the original position and extended upwards, and bone cement was used to strengthen the stability of the screws. A laminectomy is performed to achieve the purpose of decompression of the nerves. Finally, it is necessary to find the gasket that slides out between the fourth to fifth lumbar vertebrae, and then knock it forward again to move it to the correct position without damaging the nerve root or making it loose. The dura mater was broken, and then the long pole frame and the screws were locked, and the wound was closed to complete the operation. The operation was very successful.

Wu Qiming said that the main cause of the patient's lumbar screw loosening after the first operation was osteoporosis, emphasizing that the incidence of osteoporosis is the second most common epidemic in the world, and the most common cause of hip, spine and wrist About one-fifth of patients will die within one year due to complications caused by fractures, and about half of the survivors will have sequelae of poor mobility.

Wu Qiming reminded that the public should pay attention to the prevention of osteoporosis. Non-drug interventions include smoking cessation, alcohol abstinence, heavy-duty exercise, muscle strengthening exercises and balance training; Doctors discuss whether to use some osteoclast-suppressing drugs or osteoblast-stimulating drugs to avoid fracture damage.

The patient underwent a spinal revision surgery, cementing the screws for stability, and re-advancing the slipped spacer into the correct position (yellow arrow).

(Photo by reporter Chen Jianzhi)

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  • the spine

  • osteoporosis

  • spine surgery

  • lumbar nerve

  • lower extremity pain

  • Osteoclasts

  • Health Net - Bones

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