Dr. Daniel Denis

10/17/2023

Our new paper on how sacroiliac joint instability can contribute to development of a U-shaped sacral fracture even in the presence of long-standing lumbopelvic fixation. Percutaneous sacroiliac joint fusion combined with sacral fracture osteosynthesis is the solution.

Sacral fractures are pelvic ring injuries that usually occur following a fall from height and may present with neurological injury. They are divided into several subtypes based on the pattern and location of injury. Certain subtypes require operative management due to the risk of neural compromise a...

05/13/2023

Collaboration with pain management and neurosurgery can go a long way to help patients with chronic pain. This is a great example.

04/23/2023

Lateral MIS oblique and anterior interbody lumbar fusion techniques are powerful to treat severe degeneration pain and radiculopathy in patients with BMI >40. Prone lateral techniques can help fix adjacent segment degeneration with minimal morbidity. , , , , , ,

04/01/2023

11/09/2022

This patient benefited from a minimally invasive percutaneous outpatient sacroiliac joint fusion. Thanks to SI-BONE® she is now pain free!

11/03/2022

MIS lateral ALIF approach, between the bifurcation, can be performed with standard 3-blades lateral retractor. I usually add a separate fourth blade to complete the exposure. This is an example done in a patient with a high sacral slope.

11/03/2022

Discussing with LSU neurosurgery residents sacropelvic fixation and sacro-iliac joint fusion using the Bedrock Granite solution to prevent failed pelvic fixation and decrease revision rate in patients needing long construct lumbosacral fusion.

11/03/2022

75 woman who I first saw in 2019 with low back NRS 8/10 and ODI of 40%. She has been working for 50 years in a department store as retail dock worker. Her main complaint was inability to stand upright, walking or standing normally, severe back and right leg pain. Pre-op CT showed ankylosis of the facet joints from L4 to S1, degenerative scoliosis, positive sagittal plane imbalance of 12.5 cm and LL-PI mismatch of 37o. She underwent a 2 stages procedure. On day one we did bilateral L3-4, L4-5, L5-S1 Smith Petersen osteotomies and anterior column reconstruction using growing lordosis hyperlordotic expandable spacers from L1 to L5 and lateral ALIF at L5-S1. 48 hours later a T10 to pelvis posterior instrumented fusion was performed. One year after her surgery her NRS back pain is 0/10 and her ODI is 0%.Yes, she has no pain at all! She is riding a bicycle and mows her lawn regularly. She is thinking about returning to work. Deformity surgery in the elderly is life changing. A good surgical candidate, correcting the deformity and achieving fusion are key.

11/03/2022

Persistent leg pain after microdiscectomy is common. As a surgeon I want to offer neuromodulation when indicated and surgical decompression is not an option. I particularly like DRG stimulation when pain is very localized in a specific dermatoma which tends to happen with chronic radiculopathy.
47 y.o. female, was complaining of constant left lower extremity pain below the knee in the L5 and S1 distribution. Following a left L5-S1 microdiskectomy 10 years ago, some of the buttock pain improved but the left leg pain did not get better. The pain was described as severe, constant, shooting, burning. Pain was associated with allodynia. Pain was worse with
activity. The most painful area was below the knee radiating in the L5 distribution, but she had pain centered over the left SI joint area as well. Pain was affecting her gait.
We did a DRG trial, left L5 and S1, with 80% pain relief in her leg but she had persistent lumbosacral pain on the left side. During the final implantation we placed a L5 + S1 leads and added a left L1 lead. The L1 lead was added to get more lumbosacral coverage which ended up improving significantly all the pain on the left side.

09/18/2022

I am sharing this interesting case of persistent neuropathic leg pain and causalgia. I performed a microdiscectomy for a large extruded disc herniation but the patient leg pain and numbness was still significant 2 years after the initial surgery despite adequate decompression. His residual symptoms were successfully treated with L4 DRG stimulation.

09/07/2022

69 yo male with large B cell non-Hodgkin lymphoma, worsening right hand pain in the C8 distribution for more than 2 years. Pain is paroxystic, stabbing. 12 episodes of pain per day. Pain episodes lasting a few minutes, intensity from 4 to 8/10. No persistent numbness, weakness, change of temperature or vasomotor changes. MRI shows a small nerve sheath tumor on the right C8 DRG. Saw two neurosurgeons before me who recommended observation since patient is neuro intact.
I recommended right C8 DRG permanent trial. Patient has now complete pain relief during the day and sleeps better at night.
Will follow his nerve sheath tumor radiologically and clinically.

09/06/2022

Thanks to Si-Bone we had a great lab at Ochsner Kenner with our Tulane/Ochsner neurosurgery residents on SI joint dysfunction, minimally invasive lateral SI joint fusion using the iFuse implant, sacropelvic fixation using S2AI technique with the iFuse Bedrock implant and the new iFuse Bedrock Granite implant. The iFuse Bedrock Granite screw is the only implant approved that does pelvic fixation and SI jont fusion at the same time. Si-joint fusion during sacro-pelvic fixation reduces the risk of pseudoarthrosis and improves outcome by eliminating the risk of developing SI joint dysfunction post lumbosacral fusion. -relief