A Technical Nuance to Avoid Lumbar Five Radiculopathy with Anterior Lumbar Fusion and Posterior Instrumentation

April 10, 2021

Case Reports

. 2021 Mar 24;2021:5514720.

doi: 10.1155/2021/5514720.

eCollection 2021.

Affiliations

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Case Reports

Matthew T Neal et al.

Case Rep Orthop.

2021.

Abstract

The anterior lumbar interbody fusion (ALIF) is a well-established procedure used to treat a multitude of spinal pathologies. When performed at the L5-S1 level, the ALIF is often supplemented with posterior pedicle screw and rod fixation. Because the interbody device can restore disk and foraminal height, one benefit of the ALIF procedure is indirect neural decompression in the spinal canal and neural foramina. If the contour of the posterior rod is not matched to the exact position of the tulip heads on the pedicle screws, spondylolisthesis can be introduced, leading to foraminal stenosis and nerve compression. This concern is particularly germane when the posterior instrumentation is placed percutaneously without any direct foraminal decompression. In this report, we describe a patient who had an L4-S1 ALIF, resulting in new L5-S1 retrolisthesis and worsening L5 radiculopathy. Technical nuances and avoidance strategies are discussed.

Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

**Figure 1**

Preoperative lateral lumbar X-ray.

**Figure 2**

Preoperative T2 sagittal MRI demonstrating spondylolisthesis at L4-5 and foraminal stenosis at both L4-5 and L5-S1.

**Figure 3**

Intraoperative sagittal X-ray demonstrating anterior interbody grafts.

**Figure 4**

Postoperative lateral X-ray.

**Figure 5**

Postoperative sagittal T2 MRI demonstrating persistent L5 nerve compression in the L5-S1 foramen (arrow).

**Figure 6**

Postoperative sagittal CT scan demonstrating persistent L5 nerve root compression in the L5-S1 foramen (arrow).

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