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What is this picture of? I’m not sure I get it.
This was an attempted correction for a L5-S1 Spondy. Basically the 5th lumbar vertebra slips anterior (forward) over the sacrum. This stretches the spinal cord, causing pain. The correction was attempted by using posterior fixation pedicle screws and rods to pull the 5th lumbar vertebra posterior (backwards) relative to the sacrum.
Based on this image, it's hard to say - but very possible that this expensive procedure did not improve the pain the patient was experiencing. The spondy is still clearly present.
The vertebrae needn't come back to its place but still give pain relief in the long term by giving it stability. It is usually accompanied by other procedures which also reduces strain on the nerve giving relief.
BTW I am a surgeon treating and operating for back pain.
Yep, this is correct. It's not possible to conclusively determine the outcome of this particular procedure without a pre-op x-ray and the patient's feedback.
I'm sending you my MRI. We can discuss it later this afternoon, right?
As long as it's lumbar or cervical spine related, sure! But I'm not a doctor, just have spent a few years designing implants for these procedures. :)
can you tell if this image off-angle or are the pins not parallel?
looks excruciatingly painful
Looking at the vertebral body endplates, I'd say this shot is off of a true lateral by some small amount. The screw placement looks OK (or at least, not glaringly bad) to me, I'd need higher resolution or an AP (anterior-to-posterior) to say for sure.
This is Luigi Mangione's xray, showing his back pain issue.