Isthmic Spondylolisthesis: Adult grade III spondylolisthesis with back and leg pain, still doing great at 5 years post-op

Description

A 62-year-old female patient came to see Dr. Bridwell. She was slightly osteopenic, which means that she had low bone mass—not low enough to be considered osteoporosis, but not dense enough to be considered healthy.

The patient has back and leg pain caused by a long-standing Grade III lytic isthmic spondylolisthesis at L5-S1. (The ‘L’ stands for lumbar spine, your waistline level between the rib cage and pelvis. The ‘S’ is for sacrum, the end of your spine. The numbers indicate the different vertebral levels, so L5 is the fifth lumbar vertebra.) The L5 vertebra had slipped forward over the S1 vertebra.

As the disc collapses over time from the spondylolisthesis, the nerve roots get compressed and irritated to some extent, especially the L5 nerve roots. That’s what was causing her back and leg pain.

Treatment

Dr. Bridwell performed a posterior spinal fusion to reduce the spondylolisthesis. The patient was treated with wide decompression (removing pressure from the nerve roots) at L5-S1.

Then Dr. Bridwell did an instrumented fusion from L4 to the sacrum to correct the deformity. He used pedicle screws in the spine, and then he attached rods to the pedicle screws. The screws and rods held and stabilized the spine while the bones healed and fused in their new position.

The fusion was accomplished with local bone graft (the bone removed during the decompression/laminectomies) and biologic proteins. No iliac bone was harvested or used.

Result

After surgery, the patient’s back and leg pain dramatically improved. She is now 5 years post-op and doing very well. Note at 5 years post-op, she has a very solid fusion from L4 to the sacrum and is very satisfied with the surgical result. Her Oswestry score is 0 post-operatively and was 50 pre-operatively, which is a highly pathologic score.