Patient History

70 year old female with years of intractable claudicating back and bilateral radiating leg pain. Having failed conservative management she requested surgical intervention. She had bilateral ankle dorsiflexion weakness (4/5). BMI was 39.5 (height 5’ 2’’, weight 216 lbs). Bone quality was osteoporotic. Upright lumbar x-ray demonstrated grade 1 anterolisthesis at L3-4 and L5-S1 (Figure 1). MRI demonstrated lateral recess stenosis from L1-L5, and a sub-acute sacral insufficiency fracture (Figure 2A and B). CT demonstrated multilevel spondylosis (Figure 3A) with severe facet arthoropathy L2-S1 (Figure 3B) and severe left L5-S1 foraminal stenosis (Figure 3C).

Surgical Outcome:

 Laminectomy L1-S1, posterolateral instrumented fusion L2-S1, with interbody fusion L5-S1 in standard TLIF trajectory, utilizing PROLIFT (12mm x 28mm x 8-13mm) expandable interbody device. The PROLIFT device was inserted into the disc space in the collapsed configuration and then expanded with elevation of the L5 inferior endplate and further indirect decompression of the stenotic left L5-S1 foramen. Intra-operative 3D reconstruction (Figure 5) confirmed that the interbody was well positioned in the center of the disc space.

 In short term follow-up the patient indicated immediate relief of claudicating leg pain. Hardware remained in good position with no collapse or subsidence of the expandable interbody device (Figure 6).