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The patient came to the
clinic 24-April-2006 complaining of left
sciatica for
six months
without LBP. |
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|
MRI lumbar spine done
02-April-2006 showed spondylolisthesis L5-S1
with isthmolysis. There was no scoliosis
with weak dorsiflexion left foot 4/5. |
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The patient was advised to
try conservative measures. |
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The patient came 07-July-2008
claiming that his condition is deteriorating
with bilateral sciatica more to the left. |
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On examination: the patient
in agonizing pain with scoliotic stance
with SLRS 80 degrees both sides without pain. He had weak dorsiflexion right foot
4/5 and weak dorsiflexion left foot 3/5 and
planterflexion left foot 4/5. |
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|
MRI
lumbar spine which was
performed 09-July-2008 showing spondylolisthesis
L5-S1 and dynamic LSS X-rays confirmed the
presence of bilateral isthmolysis. |
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|
Laminectomy of the flail L5
was performed and foraminotomy of both L5, S1
and S2 was achieved. Lateral to the S2
root and below the trajectory of the S1 roots
the lower screws were inserted from both sides,
using the multiaxial version and 35 mm length
and 5 mm diameter. |
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|
Using image-intensifier, the
pedicles of L4 were identified and the upper
screws were inserted subsequently. All the time
check imaging was performed. The rods were
bended to accept the natural configuration of
the spine and inserted to the construct and
fixed after applying traction for 15-18 mm. A
bridge was inserted to obtain more stable
construct. |
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The harvested bone was used
to obtain fusion lateral to the rods. |
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Routine closure of the wound
and smooth postoperative recovery with
normalization of the power of both feet. |
