High-grade Spondylolisthesis: Grade IV Spondylolisthesis, restoring ability to stand up straight and walk and run without pain

Description

This 14-year-old male patient came to Dr. Bridwell because he had increasingly severe back pain and increasing difficulty walking because of the pain. He was unable to walk very far, and he had a somewhat weak foot on one side and bad limp from irritation of his nerve roots.

Through x-rays and MRIs, Dr. Bridwell determined that the patient had a high-grade spondylolisthesis; a vertebra had slipped forward very far over the vertebra beneath it.

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. (The ‘L’ stands for lumbar spine, your low back. The ‘S’ is for sacrum, the end of your spine. The numbers indicate the different vertebral levels, so L5 is the fifth lumbar vertebra.)

Then Dr. Bridwell did an instrumented fusion from L4 to the sacrum to correct the deformity. He resected—removed—part of the dome of the sacrum, and he removed the intervertebral disc in between the L5 and S1 vertebrae. Dr. Bridwell did a circumferential fusion—a fusion all the way around the vertebrae—at L5-S1.

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.

Notice the pre-op crease in the patient's abdomen is gone in the postop photos. Further, notice that the take off from his pelvis is abnormally pitched forward preoperatively and is normal postoperatively.

Result

After the surgery, the patient could walk normally and without pain. He has been substantially helped by the surgery. After decompressing the nerve roots and reducing the spondylolisthesis, his severe leg pain is completely gone.