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