Elsevier

World Neurosurgery

Volume 127, July 2019, Pages 222-226
World Neurosurgery

Case Report
Spondylolisthesis with Uncommon Congenital Deformity of L4-L5 Vertebral Fusion Treated by Oblique Lumbar Interbody Fusion

https://doi.org/10.1016/j.wneu.2019.04.021Get rights and content

Background

Diagnosis and management of congenital anomalies of the spine can be a challenge because of their complex presentations. We present an uncommon case of congenital deformity of the spine with L4-L5 vertebral fusion, mimicking a single vertebra, and L3 spondylolisthesis treated by oblique lumbar interbody fusion (OLIF).

Case Description

A 69-year-old woman presented with increasing lower back pain radiating to the left leg, with aggravation of symptoms for the past 6 months, causing difficulty in walking. She also complained of paresthesia along the L3-L5 dermatomes in both legs, with more prominence on the left side. Imaging revealed fusion deformity of the L4-L5 vertebrae, as well as degenerative spondylolisthesis at the L3-L4 level. After treatment with OLIF, the patient had an uneventful recovery period. Comparisons were made between the preoperative and 6-month follow-up visual analog scale and the Oswestry Disability Index scores. The patient showed significant improvement in the scores, as well as in her symptoms.

Conclusions

OLIF is a promising technique that can be applied in the management of degenerative disk diseases and also for deformities that may be formidable to treat by adopting the traditional posterior approach.

Introduction

Evaluation of congenital anomalies of the lumbosacral spine can be challenging due to their complexity. We present a patient who was initially diagnosed with L3 spondylolisthesis. However, 3-dimensional computed tomography imaging revealed a fusion deformity of the L4-L5 vertebrae, which appeared as a single vertebra. Moreover, the vertebral pedicles of L4 and L5 were short and thin and spinous processes were also fused, and the L4 nerve root was seen to pass through the misshapen neural foramen. Thus the initial surgical plan of performing a transforaminal lumbar interbody fusion (TLIF) was altered to oblique lumbar interbody fusion (OLIF) to prevent nerve root injury from posterior instrumentation. To our best knowledge, this is the first report of L4-L5 vertebral fusion deformity treated by OLIF.

Section snippets

Case Report

A 69-year-old woman complained of refractory lower back pain with radiation to the left lower extremity for 2 years. Her symptoms aggravated, and she experienced difficulty in walking for the past 6 months. She also complained of paresthesia along the L3 to L5 dermatomes in both lower extremities, which was more prominent on the left side. She had been diagnosed with hypertension in the past. On neurologic examination, the muscle strength of the left anterior tibial muscle and extensors of the

Discussion

Evaluation of the congenital anomalies in the lumbosacral spine is challenging due to the multiple associated findings and their complexity.1 Spinal dysraphism and caudal anomalies are always discovered prenatally or in infancy. Mohammad Samadian et al2 presented a case with L2-L3 instability caused by congenital posterior spinal agenesis, with complete absence of the lumbar posterior element. Ekiz et al3 presented a case of L1 to L4 vertebral fusion, L4 butterfly vertebra, and syringomyelia.

Acknowledgments

We would like to thank Editage (www.editage.cn) for English language editing.

References (23)

  • K. Abe et al.

    Perioperative complications in 155 patients who underwent oblique lateral interbody fusion surgery

    Spine (Phila Pa 1976)

    (2017)
  • Conflict of interest statement: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

    Cheng Cheng and Kai Wang are co–first authors.

    View full text