Related Experiment Videos
Spinal disassociation masquerading as iatrogenic listhesis above a previous fusion
Arjun Saxena1, Eli M Baron, D Greg Anderson
1Department of Orthopaedics, Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Study Design:
A case of remarkable instability adjacent to an L5-S1 fusion is reported.
Objectives:
The objective of this study was to review a case of marked instability adjacent to a prior fusion. Diagnostic workup and surgical management options are discussed.
Summary Of Background Data:
Junctional degeneration above or below the levels of a spinal fusion may be associated with instability. We present an unusual case of instability whose severity was only apparent when the patient was under general anesthesia.
Materials And Methods:
A 52-year-old man with a history of prior L5-S1 fusion presented with severe back pain and lower extremity weakness. Workup including multiple imaging methods revealed junctional degeneration and a Grade I spondylolisthesis at L4-L5 with minimal translation on dynamic imaging. Operative intervention was planned.
Results:
Intraoperative imaging revealed marked distraction at the L4-L5 disc space not apparent on preoperative dynamic films. The surgical approach was modified accordingly.
Conclusions:
Adjacent segment degeneration next to a prior lumbar fusion may be associated with extreme instability. Treatment may require complex stabilization.
Related Concept Videos
01:29Herniated Intervertebral Disc l: Introduction
01:25Secondary Spinal Cord Injury llI: Pathophysiology