Joshua Ryan, MD

Mid-50s female was lifting a heavy object and developed acute, severe radiating right leg pain. MRI radiology report was read as essentially normal, but my review identified a right L3-L4 far lateral disc herniation with extraforaminal compression of the exiting right L3 nerve root. I initially managed her conservatively with medications, physical therapy and injections, which only worked for a short time. I performed a minimally-invasive right L3-L4 extraforaminal approach and discectomy through a less than 1 inch incision. She had immediate post-operative complete resolution of her leg pain and at 1 week was pain free. Beware the far lateral disc herniation! They are often missed.

A gentleman in his late 60s presented to the emergency room with both weakness and numbness in the left arm and leg. MRI revealed a right parietal mass located in the sensory cortex and compressing the motor cortex with significant surrounding cerebral edema. I performed a right craniotomy for resection of the mass. Post-operative MRI revealed complete resection of the mass with dramatic improvement in cerebral edema. At 2 weeks after surgery the patient’s arm strength and sensation were back to normal. Tricky area to operate in, but a great result. @goodsamli

85 y/o male with severe bilateral lower extremity radiating pain worse with walking and better when leaning forward. He also had neurogenic claudication with significant limitations in ambulation. He was refractory to PT, chiropractic therapy and epidural steroid injections. He was a good candidate for a minimally-invasive approach given his high functional status and focal severe stenosis at L4-L5. I performed a minimally-invasive L4-L5 decompressive laminectomy and bilateral foraminotomy as same-day surgery through a less than 1 inch incision. Within 1 month post-op this gentleman has minimal back pain and all other symptoms have resolved. Good minimally-invasive options exist, even for elderly patients! @stryker.spine

50s y/o male with bilateral hand numbness following a car accident 2 years prior presented with 2 months of progressive and severe left arm radiating pain and numbness along with 3 days of progressive left arm weakness. Neuro exam showed 3/5 left triceps weakness. MRI cervical spine showed large acute left C6-C7 disc herniation with severe left C7 nerve root compression along with right C5-C6 disc herniation with cord compression. I performed a C5-C7 anterior cervical discectomy and fusion. The patient reported complete resolution of upper extremity pain and numbness the day after surgery. His left triceps strength was back to 5/5 at his 2-week post-op appointment. Happy patient, happy surgeon. @goodsamli @stryker.spine @catholichealthservicesli

49 y/o male with multi-year history of severe lower back pain and bilateral radiating leg pain with neurogenic claudication. He was unable to walk more than a city block or stand for more than 30 minutes. MRI and CT of lumbar spine showed severe disc degeneration and reversal of lordosis L3-S1 with L3-L4 spondylolisthesis and severe stenosis. I performed a L3-L5 lateral lumbar interbody fusion, L5-S1 posterior lumbar interbody fusion with expandable cages, and L3-S1 posterolateral fusion. Post-op x-rays show restoration of normal lumbar lordosis, complete reduction of L3-L4 spondylolisthesis, and good restoration of disc heights. At 3 months after surgery patient was pain-free. At 6 months he is back to playing golf with no pain.

31 y/o male was lifting a heavy object and developed acute severe neck pain, bilateral arm radiating pain and bilateral hand numbness. He subsequently developed gait instability and physical exam showed signs of cervical myelopathy. MRI (top) showed C5-C6 disc herniation with spinal cord compression and focal kyphotic angulation. I performed a C5-C6 disc arthroplasty (replacement). Bottom image shows pre-op CT (left) compared to post-op xray (right), revealing restoration of normal cervical lordosis. Patient had complete resolution of myelopathic symptoms and significant improvement in neck pain. This procedure is a great way to avoid a fusion operation in young patients! @orthofixspine

21 y/o female diver struck her head on the bottom of the pool with immediate onset of severe neck pain. She presented neurologically intact. Pre-op CT (top row) shows focal kyphotic angulation at the C5-C6 level with bilateral perched facets, suspicious for unstable ligamentous instability and impending spinal cord injury. MRI (lower left) confirms complete disruption of posterior ligamentous complex. I performed a C5-C6 anterior cervical discectomy and fusion with reduction of fracture/dislocation. Post-op x-ray (lower right) shows complete reduction of facets and restoration of normal lordotic alignment. Patient remained neurologically intact and was discharged home the following day. Be safe out there!

This procedure has changed the game. It’s a great tool in any minimally-invasive spine surgeon’s arsenal.

Mid-50’s female presented with many years of severe, progressive axial lower back pain and bilateral radiating groin and thigh pain. Her CT and MRI showed severe L2-L3 disc collapse and retrolisthesis along with herniation and nerve root compression. After failing chiropractic therapy, physical therapy, narcotics and multiple epidural steroid injections she was ready for surgery. I performed an L2-L3 minimally-invasive lateral interbody fusion through her abdomen as stage 1 a...nd percutaneous pedicle screw fixation as stage 2. Post-op x-rays show dramatic restoration of disc height and indirect decompression of the foramina. The patient’s back and leg pain was significantly improved immediately after the surgery. This is a 360 degree fixation construct done completely using minimally-invasive techniques. Minimal blood loss, less post-operative pain, and much shorter hospital stay than for an open approach. @goodsamli @experiencenuva @spinecare_li See more

54 y/o male presented with acute right foot drop and right arm neglect. Pre-op MRI (image 1) showed a large left fronto-parietal meningioma compressing the sensory and motor cortex. I performed a left craniotomy for resection, and post-op MRI (image 2) showed complete resection. Patient had resolution of foot drop within two days and within a month was symptom free and neurologically intact. Slow-growing tumors can still cause acute symptoms.

57 y/o female presented with several months of progressive bilateral leg weakness, numbness, peri-anal sensation loss and urinary incontinence. MRI and CT thoracic spine (image 1) showed T10-T11 severe spinal stenosis and spinal cord compression with signal change due to large, calcified ligamentum flavum focally. I performed a T10-T11 decompressive laminectomy and resection of the calcified ligaments. Post-op MRI (image 2) showed complete decompression of the spinal cord, and the patient’s pre-op symptoms all completely resolved within 1 month. The disc isn’t always the problem.

27 y/o male developed left bicep/tricep weakness and numbess in the left arm with myelopathic signs. Pre-operative MRI (image 1) shows kyphotic deformity with C5-C6 left disc herniation with spinal cord compression. I performed a C5-C6 ACDF. Patient’s pre-operative symptoms completely resolved. Post-operative x-ray compared to pre-operative MRI (image 2) shows dramatic improvement of deformity with restoration of cervical lordosis. Sometimes less is more. No need for a multi-level fusion here!

Elderly patient with history of L3-S1 decompression and fusion presented with severe bilateral leg radicular pain, back pain, and progressive stooped posture with inability to walk. MRI and preop x-ray (left and bottom right) showed adjacent segment disease with severe stenosis and spondylolisthesis at L2-L3. I performed a 2-stage operation with L2-L3 lateral interbody fusion followed by posterior decompressive laminectomy and fusion with extension to prior construct. Patient had complete resolution of leg pain post-operatively, was able to stand up straight and walks without assistance. Post-op xrays (top right) shows dramatic reduction of spondylolisthesis.

52 y/o male with long-standing severe back pain and progressive inability to ambulate with a history of L3-S1 decompressive laminectomy. He developed significant thoracolumbar junction scoliosis, flat back deformity, and severe multi-level lumbar foraminal stenosis. I performed a 2 stage operation with L2-L5 lateral interbody fusion followed by L5-S1 posterior interbody fusion and T10-pelvis instrumented fusion with posterior column osteotomies for correction of scoliosis. Patients symptoms were significantly improved within a few days postoperatively, and he is able to walk again.