50 A 52-year-old woman presented with significant mechanical low back pain, sciatica, and extensor hallucis longus weakness. Her straight leg raise was positive on the left, and she had limited lumbosacral flexion. In the immediate postoperative setting after a percutaneous fusion, she reported radicular pain. Preoperatively, computed tomography (CT) myelogram showed L4-L5 grade I spondylolisthesis and a small disc herniation at that level. Postoperatively, CT myelogram demonstrated a broad lateral extradural impression from the L4-L5 to the L5-S1 disc space level. Impingement of the pedicle screw on the exiting root was noted (Fig. 50-1). Initially, the patient had a percutaneous left L4-L5 discec-tomy, transforaminal lumbar interbody fusion (TLIF), and pedicle screw fixation. After developing a radicu-lopathy, she underwent an open procedure, involving removal of lumbar instrumentation, replacement of bilateral L4-L5 pedicle screws, morselized bone graft arthrodesis, and transverse lumbar interbody fusion. She achieved a good recovery after the second surgery.
Nerve Root Impingement by Pedicle Screw
Presentation
Radiologic Findings
Diagnosis
Treatment
Discussion
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