Circumferential Fusion using Combined Unilateral TLIF and Contralateral Pedicle Screw Fixation for Spondylolytic Spondylolisthesis at L4/5 and L5/S1: A Case Report

Abstract

Objective: A case of spondylolytic spondylolisthesis at L4/5 and L5/S1 was treated by performing 360 degree fusion using combined unilateral transforaminal lumbar interbody fusion (TLIF) and contralateral pedicle screw fixation (PSF).Case report: A 78-year-old man presented with 8-year history of low back pain and left leg pain. Neurological examination showed positive straight leg raising test on the right and hypesthesia in the left L4 region. Computerized tomography and magnetic resonance imaging demonstrated spondylolysis at L4 and L5 with slip at L4/5. The patient was treated with a single cage by performing TLIF from the left L4-5 foramen obliquely to the ventral cortex (45 degree to vertical plane), and then PSF at L4, L5 and S1 under an intraoperative fluoroscopy.Result: Postoperatively, the patient showed a marked recovery. His left leg pain and low back pain subsided, and he was back to work shortly after the operation.Conclusion: Spondylolytic spondylolisthesis is one of the targets of spinal instrumentation. Although a broad combination of implants can be selected for this pathological condition, combined TLIF after discectomy and contralateral PSF was useful in a case like this.