Case Study: Lumbar Spondylolisthesis 3
HISTORY
- 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.
PHYSICAL EXAM
- He had severe lumbar spasms, decreased range of motion and foot dorsiflexion weakness.
PREOPERATIVE IMAGING
AP and lateral dynamic X-rays showing unstable L4-5 spondylolisthesis
PREOPERATIVE IMAGING
Sagittal and axial MRI sections showing severe stenosis at L4-5. Note the severe ligamentous buckling impinging the neural elements posteriorly.
DIAGNOSIS
- L4-5 lumbar spondylolisthesis with severe lateral recess stenosis
SURGERY
- MIS (minimally invasive surgery) XLIF (extreme lateral interbody fusion) and PLF (posterior lateral fusion)
- 1 hour of operative time
- 5 cc blood loss
POSTOPERATIVE IMAGING
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.
OUTCOMES
- 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.
Hospital Affiliations
Mt. Sinai
Saint Barnabas Medical Center
Lenox Hill
Formerly St. Luke’s-Roosevelt
Hospital in Manhattan
Livingston, NJ
Formerly Lenox Hill Hospital
in Manhattan
Outpatient Surgery Centers
Malo Surgery Center
201 Route 17 North 12th floor
Rutherford, NJ 07070
Phone: 201-549-8890
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Midtown Surgery Center
305 East 47th St.
New York, NY 10017
Phone: 212-751-2100
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Advanced Spine Surgery Center
855 Lehigh Ave,
Union, NJ 07083
Phone: 908-557-9420
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Denville Surgery Center LLC
3130 Route 10 West
Denville, NJ 07834
Phone: 973-328-3475
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