2023 Volume 14 Issue 10 Pages 1332-1339
Introduction: Posterior lumbar interbody fusion (PLIF) and posterolateral fusion (PLF) are standard surgical procedures for isthmic L5 spondylolisthesis. The risk of postoperative neurological deficit associated with surgical reduction may increase in the case of severe slippage. In patients with bony bridges anteriorly or laterally at the vertebral bodies, it is difficult to reduce the slippage. We performed posterior lumbosacral fusion using a S1 transdiscal screw to avoid postoperative neurological deficit and to obtain stronger fixation and bone union. We report three cases using this technique.
Case 1: A 69-year-old woman had low back pain and right buttock pain. A lumbar radiograph and CT showed Meyerding classification grade 3, 56% slip, −3°slip angle. Disc degeneration at L5/S1 was severe and disc height was almost lost.
Case 2: A 33-year-old man had low back pain and bilateral buttock pain. A lumbar radiograph and CT showed Meyerding classification grade 3, 55% slip, 8°slip angle. Disc degeneration at L5/S1 was severe and disc height was almost lost.
Case 3: A 56-year-old man had low back pain and right buttock pain. A lumbar radiograph and CT showed Meyerding classification grade 2, 26% slip, −2°slip angle. An incomplete bony bridge at the vertebral body was formed anteriorly and laterally, and it seemed difficult to reduce the slippage and inserting the cage into the disc space.
Conclusions: Low back pain and leg pain improved in all patients after surgery, and the bone union was obtained in 1 year, suggesting that this surgical procedure is useful.
