1. 1 ProDisc L: Motion Preservation Device Performed by: Michael Janssen, DO August 20, 2007 Welcome High School Students!!!

2. The Spine 7 Cervical ▫ 8Nerve Roots 12 Thoracic ▫ 12 Nerve Roots 5 Lumbar ▫5 Nerve Roots

3. The Lumbar Spine

4. Axial View of a Vertebra

5. Disc Anatomy

6. Notice the darker than normal disc space. This is characteristic of a disc with DDD. MRI Imaging (Healthy/DDD)

7. ProDisc L Motion Preservation System Treat DDD (Degenerative Disc Disease): L3-S1 Intended to: ▫Remove diseased disc ▫Reduce discogenic pain ▫ PRESERVE MOTION IN DISC Superior & Inferior Plate ▫Cobalt Chrome Alloy ▫Central keel: fixation security Polyethylene Inlay ▫Ultra high polyethylene Developed by Synthes

8. Degenerative Disc Disease (DDD) Breakdown and deterioration of intervertebral disc Loss of water content in pulposus Stretching, degeneration, & rupture of annulus ▫Bulging of disc ▫Leads to leakage of nucleus’ content Nerve root compression Pain/numbness in associated extremities Stiffness in back Limited ability to continue desired lifestyle

9. Disc Herniation Compression/Pressure on Nerve Root: Symptoms? ▫Numbness ▫Shooting Pains ▫Tingling ▫Weakness ▫Loss of sense

11. Anterior Lumbar Discectomy & ProDisc L Abdominal Incision Abdominal muscles deflected laterally; peritoneal cavity avoided Iliac deflected laterally Midline of target disc determined; discectomy performed Placement of ProDisc L

12. Questions?

13. c/o = Complains of LBP = Lower Back Pain X = For PE = Physical Examination WNL = Within Normal Limits VAS = Pain Scale GVM = Patient Initials

14. ESI = Epidural Steroidal Injection PT = Physical Therapy VAX–D = Type of Decompression MRI = Magnetic Resonance Imaging DDD = Degenerative Disc Disease

15. X-ray Imaging

17. MRI Imaging

18. X-ray Imaging MRI Imaging Dark disc space in image to right indicates loss of water content and therefore a degenerating disc. Image above shows narrowed nerve root space where nerves are being pinched due to DDD.

19. Now its time for the surgery

20. Closing Remarks How were you challenged today? How can we improve days like this? How has today changed your view of medicine? Questions?