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The patient came
to the clinic 12-July-2006 in agonizing LBP with bilateral sciatica
and inability to walk without help. The patient was operated
elsewhere 3 times for spondylolisthesis L4-5. All the operations
were performed 2004, and up to now he is suffering from this
condition. On examination: SLRS was 5 degrees in the right and 10
degrees in the left. He had weak planter and dorsiflexion both feet
with almost drop right foot. The right foot is swollen and he is
under treatment for DVT. The patient was sent for MRI, CT-scan
and LSX-ray. The transpedicular screws inserted between L4 and L5 .
Actually, there were no pedicles of L4 body. The construct seem to
be acceptable, but the condition mandate exploration to resolve his
problem.
After exposure of the parts of the construct outside the bony
elements, check for instability was positive. The upper right
transpedicular screw was movable and the area had overmobility. The
lower screws were acceptable. The upper screws of Stryker
brand were removed and another new transpedicular polyaxial type
were inserted to the L3 pedicles. A longer rods were used and
distraction for 20 mm both sides was achieved. Bridge was inserted
between the rods to achieve more stable design.
Postoperative recovery was unexpectedly dramatic. The power of
both feet became full with disappearance of bilateral sciatica.
Comments:
1. Never use the pathologically involved pedicle for fixation.
Insert the screws to above laying normal pedicles and apply traction
from there. When the patient has isthmolysis and abnormal pedicle
alignment, jump to the normal anatomy and use that part to achieve
your mission. |
