PATIENT HISTORY

Patient is a 60 year old female who has had intermittent lower back pain for twenty years. Her pain radiates to both legs but is worse on the right side.

CHALLENGE

Patient has normal strength and sensation. She has limited range of motion of the lumbar spine due to pain. Hip irritability with rotation was positive with right hip pain.

The MRI and x-rays showed Grade 1 spondylolisthesis, modic type 2 changes and severe stenosis at the L3-4 level. There is severe stenosis and black disc at L3-4. There is also facet arthritis at the L4-5 level.

Degenerative changes at L4-5 are most prominent where there is moderate to marked foraminal stenosis on the left and moderate foraminal stenosis on the right, secondary to bulging disc material, degenerative changes, disc space narrowing and a mild spondylolisthesis at this level.

DIAGNOSIS
In the lumbar region there is spinal stenosis, retrolisthesis, and facet arthritis.

SOLUTION

This patient failed conservative nonsurgical treatment consisting of physical therapy, anti-inflammatory medications, and an exercise program. The patient underwent epidural injections with no effect. The patient was offered surgical intervention and the different options were presented including primary fusion. The patient decided to undergo surgical intervention with lumbar fusion.

The postoperative radiographs demonstrate the placement of facet screws and a PEEK interbody in the L4-L5 disc space.

OUTCOME The patient had excellent relief from her back pain. She is now 8 months from surgery and has resumed normal activities.   Patient says, "I don't have [any more] leg pain."   Click on the image to view the patient video testimonial. The video was taken 11 days post-op.