Patient History

The patient presented with girdle-like lumbar pain radiating to the right buttock and the dorsal part of the left leg down to the heel. Cramping pain occurred during movement. With any change in body position, sitting or standing, the patient assumed a forced protective posture. Visual examination revealed lumbar spine curvature and pelvic misalignment.

The patient had a history of L5/S1 herniation, for which radiofrequency nucleotomy was performed in 2013. Post-surgery, the condition somewhat improved, but radiating pain during movement developed as a postoperative consequence. Subsequent conservative treatment (nerve root blocks, injections, physical therapy) did not provide lasting improvement.

Diagnosis

Status post radiofrequency nucleotomy L5/S1 (2013) — with postoperative complications
Hypolordosis — disruption of the physiological lumbar curve
Degenerative changes and disc height reduction L4/L5
Pseudoretrolisthesis of L4 — posterior vertebral body displacement
Complete L5/S1 disc wear with bone-to-bone vertebral contact — absolute degeneration
Pseudoretrolisthesis of L5
Bilateral spondylarthrosis L4/L5 and L5/S1 — activated facet joint arthrosis
Activated osteochondrosis L4/L5 and L5/S1
Bilateral neuroforaminal stenosis L4/L5 and L5/S1
Lumbosacral destabilization
Spinal sagittal balance disruption

Surgical Report — MIBRAR® Method

Procedure performed on 02.05.2016 at the WGZM clinic (Munich) under Prof. Dr. med. Arsen Babayan. Outpatient, under local anesthesia, with fluoroscopic guidance.

Venous blood collection from Vena cephalica — separation of autologous CGF concentrate enriched with platelets, growth factors, and anti-inflammatory factors
Liposuction — harvesting of subcutaneous adipose tissue and separation of Lipogems® concentrate with regenerative substance concentration 1000 times greater than bone marrow
Intradiscal transplantation under fluoroscopic guidance into L4/L5 and L5/S1 discs — disc height, volume, and shape reconstruction
Bilateral intra-articular transplantation into L4/L5, L5/S1 facet joints — joint space widening and joint reconstruction
Peridural application into foraminal openings with dilation and lavage of neuroforamina L4/L5 and L5/S1 bilaterally

X-ray and MRI — Before, During, and 18 Months After MIBRAR®

A series of 15 images documents the staged reconstruction of L4/L5 and L5/S1 discs: from pre-operative condition through intraoperative results to 18-month follow-up. Final images show full reconstruction of both segments and sagittal balance restoration.

Pre-operative lumbar MRI: L4/L5 degeneration, L5/S1 wear, osteochondrosis

Pre-operative MRI (sagittal plane, 3 slices): Degenerative deformation L4/L5, post-surgical L5/S1 wear with bone-to-bone contact, osteochondrosis. Sagittal balance disruption.

Lumbar MRI: coronal plane — L4/L5, L5/S1 disc degeneration, scoliosis

Pre-operative MRI (coronal plane): Degenerative deformation of L4/L5 and L5/S1 discs, bony changes, right-sided scoliosis.

Lumbar MRI: axial plane — L4/L5, L5/S1 facet joint arthrosis

Pre-operative MRI (axial plane): L4/L5 and L5/S1 facet joint arthrosis — bilateral articular surface degeneration.

X-ray: intradiscal MIBRAR® transplantation L5/S1 — sagittal and frontal views

Intraoperative X-ray (sagittal): Before surgery — retrolisthesis, disc wear. Immediately after MIBRAR® — disc height increase, retrolisthesis resolved, both segments reconstructed.

X-ray: frontal view — L4/L5, L5/S1 disc reconstruction during MIBRAR® procedure

Intraoperative X-ray (frontal): Left — nearly absent L5/S1 interdisc space before surgery. Right — space increase, volume restoration of both segments.

18-month follow-up X-ray: before and after comparison — full disc reconstruction

18-month follow-up (sagittal): Comparison with pre-operative condition — full reconstruction of height and shape of both discs, retrolisthesis resolved, spinal sagittal balance restored.

18-month follow-up X-ray: frontal view — L4/L5, L5/S1 segment reconstruction

18-month follow-up (frontal): Further increase in interdisc space and reconstruction of both segments compared to intraoperative result — confirmation of ongoing regeneration.

Treatment Results

After 1 week

Complete absence of complaints and all previously described symptoms — girdle-like pain, leg radiation, cramping pain during movement. Pain medication discontinued.

After 18 months

Follow-up X-ray (10.11.2017) confirmed: full reconstruction of both L4/L5 and L5/S1 segments. Disc height and shape restored, retrolisthesis resolved, sagittal balance normalized. Regeneration continued after the procedure.

Long-term

Symptoms did not recur. The patient has no limitations in daily life, actively participates in sports. Spinal fusion and disc replacement were not required.