Unilateral Isthmus Resection for Elderly Foraminal Stenosis

We present an elderly patient with unilateral foraminal stenosis treated by isthmus resection. An 83-year-old female could not walk due to severe leg pain along right L5 sensory dermatome. Despite the laminotomy for spinal stenosis on the right side at the L4-5 level, her leg pain did not improve. Careful review of computed tomography scans and coronal source images of magnetic resonance myelography revealed foraminal stenosis on the right side at the L5 vertebra. Because of medical problem, she underwent isthmus resection on the right side at the L5 level instead of total facetectomy and fusion. After surgery, her leg pain was markedly improved. Isthmus resection showed successful result for this medically compromised elderly patient with unilateral foraminal stenosis.

Transforaminal Lumbar Interbody Fusion Using Wedged Cages for Isthmic Spondylolisthesis: A Short-Term Radiological Analysis

OBJECTIVE: The ability to induce segmental lordosis has been reported to be marginal with transforaminal lumbar interbody fusion(TLIF). Therefore, we analyzed the short-term radiological outcomes of TLIF using 8 degrees wedged cages for isthmic sp-ondylolisthesis. METHODS: Twenty-seven patients with isthmic spondyloisthesis who underwent single level TLIF with pedicle screw fixation (PSF) using 8 degrees wedged cages were retrospectively evaluated. Changes in disc height, degree of anterolisthesis, segmental lumbar lordosis, whole lumbar lordosis and L1 axis S1 distance were evaluated using standing lateral radiographs before surgery, at 6 weeks follow-up and at the final follow-up. RESULTS: The mean age of the patients was 49.9 years (range, 38 to 64 years). The affected levels were L4-5 in 17 cases and L5-S1 in 10. There were 18 cases of Grade I isthmic spondylolisthesis and 9 cases of Grade II. At a mean follow-up duration of 9.9 months (range, 6 to 18 months), the disc height (p<0.001) was significantly increased, and the degree of anterolisthesis was significantly reduced (p<0.001). Regarding the sagittal balance, the segmental lumbar lordosis was significantly increased (p=0.01), but other parameters were not significantly changed after surgery. CONCLUSION: TLIF with PSF using 8 degrees wedged cages significantly increased the segmental lumbar lordosis.