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KMID : 1146020100030020144
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Journal of Critical Spine Cases
2010 Volume.3 No. 2 p.144 ~ p.146
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Failure of Indirect Decompression Following Anterior Lumber Interbody Fusion due to Transposition of Endplate Spur into the Foramen
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Kim Jong-Won
Kim Jin-Uk
Jang Jee-Soo
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Abstract
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Anterior lumbar interbody fusion (ALIF) with percutaneous pedicle screw fixation (PPF) is a good surgical option for foraminal stenosis due to isthmic spondylolisthesis, as it results in indirect decompression of the foramen and restores disc height. However, results can be inconsistent with other pathological lesions. We report a case of failure of indirect decompression following ALIF and PPF, which needed additional direct foraminal decompression. A 53-year-old female patient underwent ALIF and PPF at L4-5 for isthmic spondylolisthesis of L4 on L5 with foraminal stenosis for the symptoms of low back and leg pain. But persistent severe right leg pain made additional surgery inevitable. Therefore, additional direct posterior foraminal decompression was performed, with resection of a displaced L4 lower endplate bony spur into the foramen by reduction of disc height, which was compressing the root. Finally her persistent symptoms relieved. In cases of spondylolisthesis combined with posterior endplate bony spur formation, anterior indirect decompression with reduction of disc height could make a newly development of root compression by transposition of spur into the foramen. To avoid this complication, resection of endplate bony spur should be included in initial surgical plan, or additional direct foraminal decompression is necessary.
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KEYWORD
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Anterior lumbar interbody fusion, Foraminal stenosis, Endplate
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