Anamnesi del paziente

For the past eight years, la paziente lamentava dolore alla colonna lombare durante la deambulazione e le rotazioni, nonché alzandosi dalla posizione seduta. Il dolore irradiava frequentemente alle gambe, especially to the left leg, with a girdle-like character.

The patient constantly experienced dull lumbar pain e intorpidimento sulla faccia esterna di entrambe le gambe, particolarmente pronunciato a sinistra. Anni di trattamento conservativo non hanno raggiunto un miglioramento duraturo. L'intervento di stabilizzazione con fusione spinale raccomandato è stato rifiutato dalla paziente.

Diagnosi

Degeneration and circumferential disc protrusion L3/L4
Deformative degeneration of L4/L5, L5/S1 discs — pronounced destruction with shape alteration
Spondylolisthesis with L4 vertebral ventralization — anterior vertebral body displacement
Circumferential stenosing central-lateral protrusion L4/L5 — caused by spondylolisthesis
Absolute foraminal stenosis L5/S1 — complete nerve canal closure
Destabilization of L4/L5, L5/S1 segments — loss of spinal column stability
Bilateral facet joint arthrosis L3/L4, L4/L5, L5/S1 — degeneration at three levels

Two-Stage Treatment — MIBRAR® Method

First Procedure — 29.02.2016

Intradiscal and intra-articular transplantation of autologous concentrates into L4/L5, L5/S1 segments:

CGF (Concentrated Growth Factors) — enriched with platelets, growth factors, and anti-inflammatory factors (from venous blood)
Lipogems® (microfragmented adipose tissue) — with high concentration of regenerative substances (from subcutaneous adipose tissue)
Injection sites: intradiscally into L4/L5 and L5/S1, intra-articularly into facet joints at both levels

Second Procedure — 20.04.2017 (after 14 months)

Trapianto intradiscale e intra-articolare ripetuto con lo stesso protocollo per potenziare e consolidare l'effetto rigenerativo:

Repeat CGF and Lipogems® implantation into L4/L5, L5/S1 discs
Goal: further disc height increase, structural reinforcement, and full repositioning of displaced L4 vertebra

Radiological Follow-up — Reconstruction Stages

Una serie di radiografie in proiezione sagittale e frontale documenta la ricostruzione discale per stadi: preoperatorio → intermediate result → final intraoperative result → 10-week follow-up → 14-month follow-up → 3-month follow-up after the second procedure.

X-ray: intradiscal MIBRAR® transplantation L5/S1 — before and after, sagittal view

L5/S1 — sagittal view: Sinistra — inserimento della sonda spinale prima dell'impianto. Destra — dopo il trapianto: evidente aumento dell'altezza del disco L5/S1 immediatamente dopo la procedura.

X-ray: 10-week and 14-month follow-up — L5/S1 disc height increase

L5/S1 — 10-week and 14-month follow-up: Progressive disc height increase continuing after the procedure. At 14-month scan — further restoration.

X-ray: second MIBRAR® procedure L5/S1 — repeat implantation, sagittal view

L5/S1 — second procedure (20.04.2017): Repeat CGF and Lipogems® implantation to consolidate results and further increase disc height.

X-ray: L4/L5 frontal view — interdisc space increase after MIBRAR®

L4/L5 — frontal view: Probe insertion before implantation. Right — after transplantation: interdisc space increase and disc shape restoration.

X-ray: L4/L5 follow-up — disc height restoration, progressive regeneration

L4/L5 — follow-up: Progressive disc shape restoration at 4 and 14 months. Height reduction stopped and reverse process initiated.

X-ray: L4/L5 sagittal — L4 ventrolisthesis before and resolution after MIBRAR®

L4/L5 — sagittal view, ventrolisthesis resolution: Before surgery — disc height reduction and L4 ventral displacement. After — height increase, partial then full vertebral repositioning to anatomically correct position.

X-ray: final follow-up 3 months after second procedure — full reconstruction L4/L5, L5/S1

Final follow-up (14.07.2017): Complete restoration of L4/L5 and L5/S1 disc height and shape. Full return of L4 vertebra to anatomically correct position — no signs of ventrolisthesis.

X-ray: before surgery and 3-month comparison — sagittal and frontal views

Before and after comparison (sagittal + frontal): Full reconstruction of both segments — disc height restoration, L4 vertebral repositioning, sagittal balance normalization. Result of ongoing post-operative regeneration.

Risultati del trattamento

After 1st procedure

Immediatamente dopo the first intervention, radiating pain to the left leg disappeared. Numbness symptoms ceased within 3 days. Lumbar pain significantly decreased within a week. Complaints reduced by 80%.

After 10 weeks

Follow-up X-ray confirmed L4/L5 and L5/S1 disc height increase. Beginning of post-operative regeneration.

After 14 months

X-ray before second procedure: further disc height increase. L4 vertebral ventralization — no significant changes. Decision made for repeat procedure for full repositioning.

After 2nd procedure

One month after the second procedure — complete absence of complaints. For the first time in 8 years, the patient is pain-free.

Follow-up 14.07.2017

Final X-ray (3 months after 2nd procedure): full reconstruction of both segments — disc height and shape restoration, full L4 repositioning, sagittal balance normalization.

A lungo termine

Symptoms did not recur. The patient has no limitations, actively participates in sports. Spinal fusion was not required.