Board Certified Neurosurgeon Brain & Spine Care 860-889-9035
Mark Hornyak, MDBoard Certified Neurosurgeon
Back to Cases

Degenerative / Spine Case

Spondylolisthesis and Lumbar Stenosis

66 yo woman presents with leg greater than back pain Greater than 1 year duration Pain radiates down back of legs Numbness and tingling in calves No weakness, but reports falling Worsens with walking, better with rest Has had injections – limited benefit Has tried PT Ibuprofen helps Smokes ½ ppd; cutting down

Description

66 yo woman presents with leg greater than back pain. The pain persisted for greater than 1 year duration. She has pain that radiates down back of legs, numbness and tingling in calves. There is no weakness, but reports falling. The pain worsens with walking, better with rest. She has had injections with limited benefit and has tried PT; Ibuprofen helps. She smokes ½ ppd; cutting down. Her BMI is 22. She has limited range of motion of back – primarily extension, has loss of sensation around shins, calves and feet, loss of ankle jerk reflex. Her gait stable, but antalgic. Patient was referred for further conservative care: PT, muscle relaxants recommended to PCP and she is asked quit smoking. She was fitted with TLSO back brace and a MRI is ordered. At 3 month follow-up visit, back and leg pain persist. Minimal improvement with PT & bracing. She is down to 3 cigarettes daily.
Based on complaints, exam findings, and findings on imaging (x-rays, and MRI), as well as failure of conservative care, patient is offered decompression and stabilization surgery

Gallery

Images

Figure 1CT abdomen from 3 years prior (2017). It shows normal alignment between L4 and L5
Figure 2Preop dynamic x-rays. These side-view images show a malalignment between L4 and L5 (called a spondylolisthesis. There is a slight change in the relationship between L4 and L5 from bending back (left, aka extension) and bending forward (right, aka flexion). Arrow points to L4/5 dsic
Figure 3Preop MRI: the side view image (left, aka sagittal) shows the L4/5 malalignment and pinching of the nerves, while the cross-cut image (right, aka axial) shows severe arthritis and the nerves being compressed (aka stenosis)
Figure 4aIntraoperative image acquired through the surgical microscope- angling in from the left side. The surgical approach has removed soft tissue overlying the spine. The image
Figure 4bBone has been removed, and the covering of the underlying nerves (the dura) has been exposed
Figure 4cThe dura is being retracted exposing the intervertebral disc which lies underneath (with some veins attached to its surface)
Figure 4dthe dura is again being retracted, the disc has been removed, and a metal implant (magenta in color) can be seen deep in the disc space.
Figure 5Image capture taken from the Stealth navigation workstation during surgery. It shows the image-guided probe within the L4/5 disc space being used to correctly size the interbody spacer and guide it into place.
Figure 6PostOp x-rays: taken 6 months after surgery, these front-on (left, aka AP) and side-view (right, aka lateral) images show the four screw, two rods and cage in position. Compare these to the

Related Videos

Watch related education

Information on this site should not be relied upon to make a medical diagnosis or determine treatment for a medical condition. Case examples are educational and de-identified. They do not represent expected outcomes for any individual patient. The information on this website is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice.