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Bilateral L5 pedicle fracture with L5-S1 spondylolisthesis after single-level L4-5 posterior lumbar interbody fusion: illustrative case – Lumbar Fusion

Day Case Lumbar Fusion Surgery

The article discusses a rare complication of L5 pedicle fracture with rapidly progressive spondylolisthesis after a single-level posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (TLIF) surgery for L4-5 isthmic spondylolisthesis. The etiology of this complication is unclear, but the authors propose that it may be caused by abnormal local shear forces on the posterior neural arch of the L5 vertebra and L5-S1 intervertebral disc, triggered by the fusion surgery for L4 shear-type spondylolisthesis. The article suggests that the L4 sagittal vertical axis may be a predictive parameter for this rare complication

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : the highest rated treatment hospital on Harley Street UK

Published article
BACKGROUND: Single-level posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (TLIF) is a commonly performed surgical procedure for L4-5 isthmic spondylolisthesis. Postoperative L5 pedicle fracture with rapidly progressive spondylolisthesis at L5-S1 segment after L4-5 PLIF/TLIF is quite rare, and the etiology remains unclear. This report describes this rare complication and proposes a possible etiology focusing on the lumbosacral sagittal imbalance characterized by…

Lumbar Fusion Surgery Expert. Best Spinal Surgeon UK
J Neurosurg Case Lessons. 2023 Aug 7;6(6):CASE23279. doi: 10.3171/CASE23279. Print 2023 Aug 7.ABSTRACTBACKGROUND: Single-level posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (TLIF) is a commonly performed surgical procedure for L4-5 isthmic spondylolisthesis. Postoperative L5 pedicle fracture with rapidly progressive spondylolisthesis at L5-S1 segment after L4-5 PLIF/TLIF is quite rare, and the etiology,

J Neurosurg Case Lessons. 2023 Aug 7;6(6):CASE23279. doi: 10.3171/CASE23279. Print 2023 Aug 7.

ABSTRACT

BACKGROUND: Single-level posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (TLIF) is a commonly performed surgical procedure for L4-5 isthmic spondylolisthesis. Postoperative L5 pedicle fracture with rapidly progressive spondylolisthesis at L5-S1 segment after L4-5 PLIF/TLIF is quite rare, and the etiology remains unclear. This report describes this rare complication and proposes a possible etiology focusing on the lumbosacral sagittal imbalance characterized by an anteriorly shifted lumbar loading axis.

OBSERVATIONS: The authors report a case complicated by L5 bilateral pedicle fractures and rapidly progressive spondylolisthesis at the L5-S1 segment very early after a single-level PLIF for L4-5 isthmic spondylolisthesis. Meyerding grade III anterolisthesis was observed at L5-S1 segment by 3 months after the initial surgery. Additional surgery was performed, and the fixation was extended to L4-ilium. Fracture healing was observed at 6 months postoperatively.

LESSONS: This complication may have been caused by abnormal local shear forces on the posterior neural arch of L5 vertebra and L5-S1 intervertebral disc, which were triggered by the fusion surgery for L4 shear-type spondylolisthesis. L4 sagittal vertical axis is considered a reasonable parameter representing lumbosacral sagittal imbalance with an anteriorly shifted loading axis and may be a candidate for the predictive parameters of this rare complication.

PMID:37581583 | DOI:10.3171/CASE23279

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Read the original publication:
Bilateral L5 pedicle fracture with L5-S1 spondylolisthesis after single-level L4-5 posterior lumbar interbody fusion: illustrative case

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Truspilot Reviews

SW
SW
2022-06-10
Fabulous service Fabulous service. Mr Akmal truly cares about his patients and how he can improve their quality of life. I would recommend him to anyone with any kind of spinal issue.
Honeywell Paul
Honeywell Paul
2022-06-08
Truly excellent results! I was diagnosed with lumbar stenosis after experiencing increasing pain in both legs. An MRI and consultation carried out at short notice confirmed this. Mr Akmal recommended that a spacer should be inserted in my lower back to correct the problem and release the nerves from the narrowing caused by stenosis. The operation was conducted very professionally and without pain. After the first two weeks the pain started to subside as expected. After 4 weeks I was completely back to normal. The result is exceptionally good and I feel renewed, with no pain whatsoever and a regained posture, ready to resume a normal life. I cannot recommend The London Spine Unit highly enough. They are medical magicians!
c etri
c etri
2022-06-06
Sciatica My mother was in absolute agony for more than 3 months due to sciatica. It just came out of nowhere and took her out of action. From working full time she went straight to being bed bound and unable to carry out simplest of actions.The pain was 9/10 and she was bed bound for those three months. Multiple trips to A&E and GP and they wouldn't class it as an emergency therefore they wouldn't do anything about it other than upgrading the painkillers which did next to nothing for my mother. I couldn't bear to watch my mother sleeping on A&E bench in pain for 7 hours, just to be told by doctors that she wouldn't be kept in. I remember her joining her hands and begging the doctors to stop the pain which broke my heart. I then started doing research on google and London spine unit came up with Dr Mo AKMAL's profile and review. First meeting with Dr AKMAL was via ZOOM as my mother was bed bound. Dr AKMAL spoke to me and my mom and told us that this is nothing to worry about and that the pain would be 100% gone.Dr AKMAL assured us to visit the hospital so he could physically inspect my mother and give us the best solution. One trip to the london spine unit and Dr AKMAL advised us that the best solution would be to carry out Minimally invasive disectomy. Dr AKMAL advised that due to my mother being bed bound for a while, steroid injection might not give the result that my mother wishes. Dr AKMAL was very confident and showed us some videos from other patients who had gone through the same ordeal. The biggest thing i noticed between before and after was the smile on the patients face. Dr AKMAL was constantly assuring my mother throughout the meeting that he would take care of her pain and gave her 100% confidence that the result would be delivered.He promised her that she would be walking pain free the same day after the operation. Before the operation Dr GURUNG was consulted multiple times and he also was very helpful. Right after the surgery, as Dr AKMAL promised, my mother was walking and the biggest thing was that the pain was gone. My mother had forgotten to smile for three months and there i saw her smiling again. Dr AKMAL and Dr GURUNG gave us brilliant aftercare and informed us that just give them a ring if there was any issue. Its been several weeks now and my mother is heading towards complete recovery without any issues. The pain is completely gone and anyone who is reading this going through the same horrible sciatica pain you must come and see Dr AKMAL. Thank you Dr AKMAL and your whole team for helping my mom achieve this pain free life.
Frank Otuo
Frank Otuo
2022-05-18
Extraordinary Care My 81 year old mother who has retired in Ghana was suffering from severe lower back pain so a local surgeon put her through discectomy with hardware (spine screws). The procedure was essentially botched, with one screw breaching her spinal canal resulting in extreme pain; unable to walk, pins and needles and numbness in the left leg. The hardware subsequently had become infected and loosened as a result. Her life after this surgery was the worse she has ever experienced in all her life. She had no doubt that she was eventually to die from the infection and pain. Fortunately, through diligent search, we found Mr Akmal and his team at The UK Spine Centre. She had a zoom consultation and with a ready MRI and CT scan, Mr Akmal knew exactly how to have her back to fitness and a better quality of life. She travelled to England on 26 March 2022 and had the surgery on 11 April 2022. It was a day-case. It lasted no more than 1 hour 30 minutes. She was on my feet within 2 hours pain free - still pain free 5 weeks on! To her this is simply a miracle ! She is grateful to Jehovah God for Mr Akmal and his team - thoroughly professional bunch at the top of their game. No one deserves to suffer the pain she experienced for two years. She seriously recommends Mr Akmal and his team for anything SPINE!
Luke O'Brien
Luke O'Brien
2022-05-18
Bilateral discectomy and dynamic stabilisation for complete foot drop From the first phone call, the team at London Spine have been amazing. I had severe symptoms following an L4/L5 disc injury from playing sports and had complete foot drop. Mr Akmal and his team treated the situation incredibly sensitively, as I had risk of permanent damage. The whole process was so quick, from initial consultation to operation was about 96 hours. On the day of the operation, the nurses couldn’t have been more helpful, attentive and calming. The surgery was flawless, with absolutely zero pain from the operation following. I am now 8 weeks from a bi-lateral discectomy and dynamic stabilisation procedure and have regained full use of my leg and toes, with a complete range of motion also. Mr Akmal’s aftercare has been first class, with regular calls from his team in the 2 weeks following the surgery, to the final consultation and discharge. Thanks so much for giving me my life back
AB
AB
2022-05-09
Excellent treatment Mr Mo Akmal treated me very successfully for 2 torn discs in my back. I was in tremendous pain before I was referred to him. The treatment I received from him was excellent and he communicated with me very well throughout the whole process. I am eternally grateful to Mr Akmal for sorting out my back and would highly recommend him.
shahnaz Choudhury
shahnaz Choudhury
2022-04-22
I had a massive bulging disk on my back… I had a massive bulging disk on my back compressing my nerve for three years. It caused me excruciating pain and almost left me disabled. I was on both crutches and completely homebound due to the severity of pain and mobility limitations. I had my lumber surgery two weeks ago and walked out of hospital within a few hours pain free on my right leg that was almost paralysing prior to surgery. The disk was shaved off releasing the nerve completely. Two days after surgery I had excruciating pain on my head that is unexplained as I had CT scan and MRI which were all fine. Dr Akmal has suggested it could be from the anaesthetic. I am extremely grateful to Dr Akmal and his very welcoming and cari g team. I would highly recommend his clinic as I have had excellent recovery.
MR HARVEY
MR HARVEY
2022-04-02
Thank you Mr Aklam After having a poor and very slow experiance in glasgow . I contacted Mr mo Amlam . Who is a true gentleman, great listener and paitent . We transfered my scans and treatments from glasgow to harley street . Mr Aklams p.a arranged a quick zoom to start our contact .I then went down for a meeting and examination and what should have been a spec scan .only to be told of a UK shortage . So 4 weeks later the scan took place in wellington hospital . Before I traveled back to glasgow. 5 days later I got a call to book me in to 19 harley street for a l3 and l4 debridement and stabilisation. The opp took place on 24th March. 2hours I was out walking 4 hours later . My pain in back groin and foot was all gone .thanks to Mr aklam . Top of his craft but more importantly pouts his patients first .he really wants to help you get better. Thank you so much Mr Robert harvey
Ken Carswell
Ken Carswell
2022-03-22
Amazing service and an amazing treatment! I can't thank Mr Akmal and team at the London Spine Unit enough for their help. I had a herniated disc in my back which was causing pain and restrictions. Compared to other offers of surgery (e.g. several nights in hospital), the day surgery and minimally invasive procedure were hugely appealing. I am now 3 weeks post surgery, have no pain and am recovering incredibly quickly if I compare myself to friends who have had a similar procedure. it was truly remarkable, straightforward and the team were kind, friendly and always helpful. very highly recommended!
customer
customer
2022-03-17
Great service and painless procedure Great service and painless procedure. Definitely alleviated the pain
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J Neurosurg Case Lessons. 2023 Aug 7;6(6):CASE23279. doi: 10.3171/CASE23279. Print 2023 Aug 7.ABSTRACTBACKGROUND: Single-level posterior lumbar interbody fusion (PLIF) or transforaminal lumbar interbody fusion (TLIF) is a commonly performed surgical procedure for L4-5 isthmic spondylolisthesis. Postoperative L5 pedicle fracture with rapidly progressive spondylolisthesis at L5-S1 segment after L4-5 PLIF/TLIF is quite rare, and the etiology
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