Multilevel Posterior Lumbar Interbody Fusion

47
Multilevel Posterior Lumbar Interbody Fusion


Presentation


A 44-year-old woman presented with chronic mechanical low back pain and antalgic weakness of the hip flexors. She has an obese habitus and is a heavy smoker.


Radiologic Findings


T1-weighted magnetic resonance imaging (MRI) of the lumbar spine shows degenerative changes at L3-L4 and L4-L5, with decreased disc space height, anterior osteo-phytes, and Modic end-plate changes indicating anterior column instability. There is multilevel lumbar facet hypertrophy as well (Fig. 47-1).


Diagnosis


Lumbar instability


Treatment


This patient had bilateral L3-L4, L4-L5 laminectomies and posterior lumbar interbody fusions, with an L3-S1 pedicle screw fixation.


Discussion


The presence of Modic end-plate changes indicates anterior column instability, which typically presents with severe mechanical back pain. Following interbody fusion, with more normal restoration of disc height, mechanical back pain improves significantly when compared with posterolateral fusion alone.


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Jul 16, 2016 | Posted by in NEUROLOGY | Comments Off on Multilevel Posterior Lumbar Interbody Fusion

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