Neurosurgery

Grade 2 L5-S1 Isthmic Spondylolisthesis with Radiculopathy

PREOPERATIVE DIAGNOSIS:

Grade 2 L5-S1 isthmic spondylolisthesis with radiculopathy. 

POSTOPERATIVE DIAGNOSIS:  

Grade 2 L5-S1 isthmic spondylolisthesis with radiculopathy. 

PROCEDURE:

1.  Anterior L5-S1 diskectomy, L5-S1 arthrodesis with pre-fashioned femoral ring Allograft packed with Helos bone substitute.

2.  L5-S1 endoscopic placement of pedicle screws and endoscopic L5-S1 bilateral foraminotomies.

3.  L5-S1 arthrodesis instrumentation using pedicle screws X four, placed X two.

4.  Open reduction of grade 2 spondylolisthesis.

INDICATIONS: 

The patient is a 47-year-old gentleman with a long history of low back and bilateral lower extremity pain, left worse than right.  The patient was managed conservatively.  However when his pain progressively worsened to 8-10/10, a work up was obtained.  He had grade 2 L5-S1 isthmic spondylolisthesis with clear defect on oblique x-ray views.  Due to the fact that the patient had disabling pain, the decision was made to proceed with surgical treatment.  It was decided to go anteriorly to clean out the degenerative disk and then attempt to reduce posteriorly using endoscope pedicle screws system. The patient was informed of the procedure and risk and he signed the consent form.

DESCRIPTION OF PROCEDURE:

The patient was brought to the operating room and placed supine on the OR table.  Using a Pfannenstiel incision, Dr. A of trauma surgery provided anterior retroperitoneal exposure from L5 to S1 after the patient was sterilely prepped and draped.  L5-S1 diskectomy was then performed and using lateral image destruction was performed at L5-S1 disk space and end plates were decorticated.  12 mm pre-fashioned femoral ring Allograft packed with Helos strip was placed.  Afterwards grade 2 spondylolisthesis was reduced to grade 1.  The incision was then closed by Dr. A.  The patient was then turned prone onto the vertical bolsters.  Using C-arm, entry point for the endoscopic pedicle screw placement was determined and an incision was made first on the left side and then on the right side.  Using the endoscopic apparatus, L5 and S1 pedicle screws were placed on the left side.  Then using a high speed drill and Kerasin rongeur and curette, L5-S1 foraminotomy was performed to take the pressure off the exiting L5 nerve root.  The plate was then positioned and tightened down.  This was performed on the right side and afterwards the patient had complete reduction of the isthmic spondylolisthesis.  Bilateral transverse process of L5 and sacroiliac were decorticated and Helos strips were placed.  The wound was then closed in multiple layers after hemostasis was achieved. 

COMPLICATIONS:  None.

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