Case Study: Lumbar Spondylolisthesis 3
- The patient is a 65-year-old athletic male with severe low back pain and foot weakness. He exercised regularly but had to give up his workout routine because of worsening back pain.
- He had severe lumbar spasms, decreased range of motion and foot dorsiflexion weakness.
AP and lateral dynamic X-rays showing unstable L4-5 spondylolisthesis
Sagittal and axial MRI sections showing severe stenosis at L4-5. Note the severe ligamentous buckling impinging the neural elements posteriorly.
- L4-5 lumbar spondylolisthesis with severe lateral recess stenosis
- MIS (minimally invasive surgery) XLIF (extreme lateral interbody fusion) and PLF (posterior lateral fusion)
- 1 hour of operative time
- 5 cc blood loss
AP and lateral X-rays showing correction of the L4-5 spondylolisthesis with a cage placed through a small access portal by splitting the fibers of the iliopsoas muscle (hip flexor) and percutaneous screws placed between muscle planes with no muscle stripping. This was all done with the patient laying on his side in a lateral position.
- The patient was discharged home six hours after surgery with only mild discomfort.
- In a patient with his characteristics (athletic, older male who wanted to go back to the gym as soon as possible), MIS surgery performed through tubular retractors between muscle planes with minimal postsurgical pain and swelling allowed him to go back to exercising without any limitations in six weeks.
Saint Barnabas Medical Center
Formerly St. Luke’s-Roosevelt
Hospital in Manhattan
Formerly Lenox Hill Hospital