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Case Study: Correcting Lumbar Spondylolisthesis with TLIF

April 18, 2019 5 min read
reviewing x-ray of lumbar spondylolisthesis before TLIF

One of a doctor’s greatest rewards is seeing a patient make significant improvements after a procedure. The joy of seeing a patient thrive affirms the value of orthopedic surgery in improving the quality of people’s lives.

Meet the Patient

Recently, Dr. Daveed Frazier met with a young school teacher who was suffering from years of lower back and leg pain. At age 34, she was considered obese, weighing in at 340 pounds. Her pain prevented her from exercising. Moreover, she had developed a dependence on narcotic pain medications to cope with her discomfort.

In addition to her physical ailments, she had a history of depression. Without help, her situation could quickly become dire.

During the initial examination, Dr. Frazier noted severe lumbar muscle spasms, stiffness, and a change in sensation in both legs. He suspected lumbar spondylolisthesis may be to blame.

What is Spondylolisthesis?

Spondylolisthesis is a condition when one of the bones in the spine, known as a vertebra, slips forward and out of place. This usually occurs in the lower back. In many cases, this is due to the general aging process.

As we age, the bones, joints, and discs supporting our spinal column slowly begin to deteriorate. Degenerative spondylolisthesis occurs when the discs or joints weaken to the point where they can no longer hold the spinal column in place. Eventually, a collapsed disc or overworked joint causes a shift in the spinal column. This usually occurs in adults over the age of 50.

Isthmic spondylolisthesis, on the other hand, can occur in younger individuals—even children and adolescents. This form of spondylolisthesis occurs due to a fracture in the pars interarticularis—a small bone connecting the facet joints. Located at the back of the spine, these joints allow for forward and backward movement of the spine. When the pars interarticularis fractures, known as spondylolysis, it can compromise the integrity of the spine, leading the vertebrae to slip.

Isthmic spondylolisthesis is most common at the lowest level of the spine where the lumbar section connects to the sacrum (L5-S1). It is usually due to repeated stress in the area, such as one would sustain during contact sports.

Symptoms of Spondylolisthesis

Common symptoms of lumbar spondylolisthesis often include:

  • Deep aching pains in the lower back
  • Pain, known as radiculopathy or sciatica, that radiates to other areas of the body—like the legs
  • Worsening pain while standing, walking, or performing activities that require backward bends
  • Reduction of pain while sitting or reclining
  • A numbing or tingling sensation in the legs as well as hamstring tightness, especially after activities

Diagnosing & Treating Spondylolisthesis

Given the patient’s symptoms and overall health, Dr. Frazier ordered diagnostic imaging in the form of front-to-back (AP) and side (lateral) X-rays. The images indicated L5-S1 spondylolisthesis. Additionally, the x-rays revealed a collapsed disc between the two vertebrae.

As a result, Dr. Frazier diagnosed the patient with lumbar spondylolisthesis with pars interarticularis fractures on both sides of the bone. He determined that a transforminal lumbar interbody fusion (TLIF) surgery was the best course of action.

Understanding TLIF Surgery

Transforaminal Lumbar Interbody Fusion (TLIF) surgery is one of a few spinal lumbar spinal fusion techniques used by orthopedic doctors. Dr. Frazier chose this technique given the patient’s relatively young age and physical condition. This surgery was performed with minimal damage to the muscles. As a result, the patient was exposed to a reduced risk for future back surgeries.

The goal of spinal fusion surgeries is to increase the stability of the spine using a bone graft or other spinal instrumentation. In time, the bone graft fuses two or more vertebrae, eliminating movement between the bones. The surgery also helps reduce the painful effects of nerve irritation. TLIF surgery is usually recommended for individuals with spondylolisthesis as well as degenerative disc disease or chronic herniated discs.

TLIF surgery uses a posterior approach. This means a small incision in the back gives the doctor access to the spine, using a tiny camera and surgical equipment. After removing damaged facet joints and disc material, the doctor fuses both the front and back columns of the spine. The front of the spine is stabilized with a bone graft and secured by an interbody cage. The back of the spine is also secured with pedicle screws or other spinal instrumentation.

In the case of this patient, the minimally invasive surgery used a bone graft with percutaneous pedicle screws placed between the muscle planes.

After the surgery, X-rays of the lumbar spine showed a correction of the spondylolisthesis. In addition, the disc space was restored with the help of the interbody cage and pedicle screws.

Minimally Invasive Spine Surgery (MISS) in Action

Compared to more traditional open back surgeries, MISS offers several benefits to patients. Let’s take a look at how this patient benefited from a minimally invasive TLIF procedure.

  • Less time on the operating table. This patient’s operation lasted a little more than an hour.
  • Minimal blood loss. During the operation, the patient only lost 11 ccs of blood. This is less than a tablespoon.
  • Less damage to the area. Since Dr. Frazier inserted the pedicle screws between muscle planes, there was no need for any dissections or other painful damage to the area.
  • Reduced pain after the operation. Less damage also meant nearly immediate pain relief. In the case of this patient, she felt her back pain resolved. She only complained of some incisional pain (which is normal) after the surgery.
  • Returning to the comforts of home quicker. This MISS surgery allowed the patient to go home the same day of the procedure.
  • Quicker recovery time. The patient was able to return to her teaching job two weeks after the TLIF surgery.

Another Success Story Thanks to Dr. Frazier

Six months after the surgery, the patient reported a significant increase in mobility with no back or leg pain. In fact, she was able to start exercising regularly. As a result, she lost 140 pounds. Her depression also lifted and she no longer needed to rely on narcotic pain medications.

As you can see, this minimally invasive procedure completely changed the patient’s life. Instead of struggling to function with daily activities, she once again had the ability to take control of her life.

Are you ready to find out how Dr. Frazier and his experienced team at New York City Spine can help you? Dr. Frazier believes that each new patient coming to the practice deserves to be treated like family. He takes the time to listen to your symptoms, goals, and fears. Since surgery isn’t always the first line of treatment, he teams up with a group of physical, occupational, and massage therapists to ensure that you receive specialized care for your needs.

Are you ready to discover why the New York Times Magazine awarded Dr. Frazier as a “New York Super Doctor” twice? Call (855) 210-0899 today to schedule a consultation. You don’t need to live a life burdened with pain. Let Dr. Frazier help you.