Spondylolisthesis and Idiopathic Sarcopenia Treated With Minimally Invasive Surgery for Transforaminal Lumbar...

Sarcopenia is a muscle-wasting disease common among older adults. The condition has been associated with adverse perioperative and postoperative outcomes following spinal surgery. The combination of this muscle-wasting syndrome and spondylolisthesis and how we approached the case makes it a compelling study for surgeons attempting to treat this patient population more effectively. In this case study, we examine a 76-year-old male patient with chronic sarcopenia who needed transforaminal lumbar interbody fusion (TLIF) surgery for his grade 1 L4-5 spondylolisthesis, L4-5 degenerative disc disease, bilateral facet effusions and lumbosacral radiculopathy with active and chronic denervation. He consulted our neurosurgeon for his back pain and left lower extremity paresthesia. Magnetic resonance imaging (MRI) showed degenerative disc disease with bilateral facet effusion in multiple levels of the lumbar spine as well as broad disc bulge in L5-S1. Due to the patient's past medical history of muscle wasting disease, a muscle biopsy of the left quadriceps was performed and revealed rare denervated fibers indicative of sarcopenia. Minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) was performed as the most optimal surgical method for this condition. The patient experienced a massive decline in his VAS score from 9/10 to 0/10 two months from surgery, reflecting the fast wound healing process and recovery. Postoperatively, the AP X-ray of the lumbar spine showed dextroscoliosis and stable L4/5 TLIF instrumentation. The surgeon provided the patient guidance regarding his nutrition and exercise to maximize the treatment. This case illustrates the employment of the minimally invasive surgery (MIS) approach to diminish complications and tissue trauma of patients with sarcopenia and spondylolisthesis who are undergoing lumbar spine surgery.