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Case Review:42 year old femalewith Grade 3 IsthmicSpondylolisthesisRobert S Pashman, MDScoliosis and Spinal Deformity Surg...
Patient History42-year-old female who is quite athletic.The patient was a competitive swimmer whose primary eventswere bre...
Pre-op X-rays           Grade 3 Isthmic           Spondylolisthesis with           significant slip angle           degene...
Flexion and Extension X-rays
Indications for Surgery1. Grade 3 Isthmic Spondylolisthesis, L5-S1.2. Degenerative disk disease, L4-5.3. Evolving motor se...
Surgical StrategyAbdominal retroperitoneal approach to the lumbosacral spine.Subtotal vertebrectomy, L5, with removal of L...
Surgical Strategy – Part twoSegmental spinal instrumentation L4 to S1 using the AllezLaguna titanium pedicle screw/rod con...
Post-Op Films
Pre-Op/Post-op Comparison                   The slip angle was                   reduced from a                   Grade 3 ...
Pre-Op/Post-op Comparison
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Case Review: 42 year old woman with Grade 3 Isthmic Spondylolisthesis

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A 42 year old very athletic woman presented with Grade 3 Isthmic Spondylolisthesis. She had a long history of back pain. Dr. Pashman performed an anterior and posterior spinal fusion.

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Transcript of "Case Review: 42 year old woman with Grade 3 Isthmic Spondylolisthesis"

  1. 1. Case Review:42 year old femalewith Grade 3 IsthmicSpondylolisthesisRobert S Pashman, MDScoliosis and Spinal Deformity Surgerywww.eSpine.com
  2. 2. Patient History42-year-old female who is quite athletic.The patient was a competitive swimmer whose primary eventswere breaststroke and butterfly, both hyperextension events.The patient had some low back pain when she was a child, andshe had this investigated, but in the intervening time she reallyhad no problem until recently.Low back painOn physical examination, she has significant sacral promontory.The patient has significant rotation of the pelvis consistent withgrade 3 Isthmic Spondylolisthesis. She has hamstring tighteningand definite weakness of the dorsiflexors and extensor hallucislongus of left leg, paresthesias and numbness in the L5distribution of the legs bilaterally.
  3. 3. Pre-op X-rays Grade 3 Isthmic Spondylolisthesis with significant slip angle degeneration, retrolisthesis of L4 on L5, bilateral pars fractures, compression of the L5 nerve root, lateral recess stenosis at L4-5, and significant slip angle and junctional lumbar kyphosis.
  4. 4. Flexion and Extension X-rays
  5. 5. Indications for Surgery1. Grade 3 Isthmic Spondylolisthesis, L5-S1.2. Degenerative disk disease, L4-5.3. Evolving motor sensory deficit with weakness of extensor hallucis longus, tibialis anterior bilaterally indicating L5 nerve root crush.4. Increasing low back pain due to significant progressive isthmic spondylolisthesis and hyperlordosis, lumbar spine.5. Bilateral pars fractures pars interarticularis, L5.
  6. 6. Surgical StrategyAbdominal retroperitoneal approach to the lumbosacral spine.Subtotal vertebrectomy, L5, with removal of L5 overhangconstituting greater than 1/3 of vertebra for entrance andreduction of spondylolisthesis, L5-S1.Radical diskectomy, L5-S1, including epidural decompression.Interbody fusion with 8 x small millimeter grafts withautogenous vertebrectomy bone centrally.Anterior screw fixation of fully threaded screw over a washer,L5- S1.Spondylolisthesis reduction.Intraoperative fluoroscopic interpretation.
  7. 7. Surgical Strategy – Part twoSegmental spinal instrumentation L4 to S1 using the AllezLaguna titanium pedicle screw/rod construct, 5.5 titanium.Complete laminectomy Gill fragment of L5 lamina under loupemagnification and microscope.Neuroforaminotomy with removal of bilateral parsinterarticularis callus, L5-S1, under the microscope.Posterolateral and posterior fusion, L4 to S1, using locallyharvested autogenous bone, including laminectomy and anteriorvertebrectomy bone.Intraoperative fluoroscopy management.Spondylolisthesis reduction at L-S1.Intraoperative O-arm neuronavigation and interpretation.
  8. 8. Post-Op Films
  9. 9. Pre-Op/Post-op Comparison The slip angle was reduced from a Grade 3 to a Grade 1
  10. 10. Pre-Op/Post-op Comparison
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