Abstract
We report two case of lumbar fusion for multiple spondylolithesis.
The patients were women aged 54 and 70 years who complained of leg or buttock pain in addition to lower back pain. All lytic defects were bilateral and located at L4 and L5. We performed removal of the L4 floating lamina and ragged edge at L4 and L5, translateral or posterior lumbar interbody fusion (TLIF or PLIF) and direct repair and bone grafting of the L5 pars defect. Postoperatively, computed tomography (CT) was performed at the latest follow-up to assess the healing of the bone defects.
Lumbosacral fusion is the most common operation for multiple-level spondylolithesis, and has been proven to be effective for lumbar spinal disorders such as pseudoarthritis, loosening of screws, or adjacent segment degeneration. In our patients, no fusion at L5-S was carried out. The clinical result was good, but careful follow-up of these cases will be necessary. Direct repair of multiple-level spondylolysis using a pedicle screw laminar hook and autogenous bone graft is useful if the slip and disc degeneration is intermediate grade at the L5-S level.
