Spondylolisthesis Case 3

Case Review #3: Grade 5 Spondylolisthesis from Robert Pashman

43 year old female status post two lumbar surgeries, presented with leg pain. She underwent spinal fusion surgery to resolve her symptoms.

Case Review:

Spondylolisthesis Grade V treated with an Anterior and Posterior Spinal Fusion and resection of L5

Patient History:

43-year-old femaleLong history of low back pain, increasingStatus post lumbar fusion in 1977, following motor vehicleaccidentStatus post lumbar decompression in 1987Right leg pain and weaknessLeft leg radiculopathy. The patient is unable to stand up straight.

Pre-op Films:

L5 vertebra has fallen off of S1

Indications for Surgery:

Grade V Spondylolisthesis L5-S1.Severe lumbosacral kyphosis.Impending cauda equina syndrome due to spinal canalcompression, L4-5 and L5-S1.Previously failed L5-S1 fusion.Status post laminectomy and posterior fusion, now with apseudarthrosis.Severe low back pain and radiculopathy of the lower extremities dueto pseudarthrosis and increasing sagittal plane deformity.Motor sensory deficit preoperatively, lower extremities, includingweakness in the feet bilaterally.

Surgical Strategy – Stage One:

Anterior L5 vertebrectomy.
Anterior L4-5 and L5-S1 diskectomies.
Subtotal vertebrectomy L4.
Abdominal retroperitoneal approach to the lumbosacral spine.
Intraoperative somatosensory evoked potentials.
Intraoperative fluoroscopy.

Stage Two:

Re-exploration and decompression laminectomy of lumbar-5, re-exploration and decompression laminectomy of lumbar
Completion resection vertebrectomy, lumbar-5, status post anterior corpectomy.
Sacral laminectomy.
Segmental spinal instrumentation, lumbar-2 to sacral pelvis, with Moss Miami SI titanium screw-rod pelvic fixation instrumentation.
Reduction of spondyloptosis after resection of lumbar-5 with placement of lumbar-4 on the sacrum.
Intraoperative somatosensory-evoked potentials.
Intraoperative fluoroscopy.
Posterolateral intertransverse fusion, lumbar-2 to the sacral pelvis, using locally-harvested autogenous bone and RH bone morphogenic protein.

Pre-Op/Post-op Comparison:

L5 improve the patient’s stability and balance.