Personalized Approaches to Spine Surgery

Algorithm for optimization of preoperative bone mineral density. *Evidence for bisphosphonates (eg, alendronate) is inconclusive and, at this time, not recommended for use 6 mo pre- or postoperatively.

A 78-year-old man with a history of prior lumbar laminectomy underwent a 2-stage lumbosacral fusion: L3–L5 anterior lumbar interbody fusion and L2-pelvic minimally invasive fixation for severe back pain, right leg pain, and chronic right foot weakness. (A) Preoperative anteroposterior and (B) lateral full spinal imaging generated from an EOS scan, revealing severe degenerative changes, spinal stenosis worst at L2–L3 and L3–L4, and scoliosis with a significant mismatch between lumbar lordosis and pelvic incidence. (C) Postoperative coronal and (D) sagittal full spinal imaging generated from EOS showing instrumentation.

Fifty-two-year old man who underwent a T7 corpectomy with en bloc resection of a grade 2 chondrosarcoma and T5–T9 posterior fusion. This is an example of a case in which a custom implant would have been advantageous given the irregular margins of the tumor resection cavity. (A) Preoperative T1-post gadolinium magnetic resonance imaging revealed a 1.4 cm bony destructive mass within the T7 vertebral body and left pedicle with expansile component to the left paravertebral space and also left epidural component abutting the thoracic cord without cord compression (inset). (B) Postoperative computed tomography scan demonstrating an expandable titanium cage flush to the endplates of T6 and T8. (C) and (D) Postoperative stitched standing scoliosis films demonstrating anterior and posterior instrumentation.