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A 64-year old female presents with severe low back pain and bilateral leg pain, worse on the right. An AP and lateral radiograph in extension are shown in Figures A and B respectively. After extensive nonoperative management fails to provide any significant pain relief, surgical intervention is performed. A laminectomy and instrumented fusion is performed and shown in Figure C. What would be the most likely neurologic deficit found in the postoperative period?
Weakness to ankle plantar flexion.
Weakness to great toe extension
Weakness to Hip Flexion
Loss of the patellar reflex
Bowel and bladder dysfunction saddle anesthesia
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A correlation has been found between Pelvic Incidence (PI) and spondylolisthesis. Based on the angles X,Y, and Z shown in Figure A, B, and C, which of the following most accurately determines the Pelvic Incidence (PI) in this patient?
Angle Z + Angle Y
Angle X - Angle Y
Angle X - Angle Z
Studies have shown a direct relationship between pelvic incidence and isthmic spondylolisthesis, suggesting that pelvic anatomy has a direct influence on the development of this condition. Which angle in Figure A-E best illustrates the measurement of pelvic incidence.
Angle E (Figure A)
Angle X (Figure B)
Angle Z (Figure C)
Angle Y (Figure D)
Angle V (Figure E)
You are seeing a 28-year-old female for lower back pain after she fell off a horse 2 days ago. She has no neurologic deficits. A lateral radiograph and axial CT scan are shown in Figures A and B, respectively. What is the most appropriate first line of treatment?
Observation, mobilization, and further treatment based on symptoms
Spinal casting and bed rest for 6 weeks
Thoracolumbosacral orthosis for 6-8 weeks
Open reduction and internal fixation
L5 to S1 posterior spinal fusion with instrumentation
A 26-year-old male presents with chronic back and bilateral leg pain that has not improved with extensive nonoperative management including physical therapy, oral medications, and corticosteroid injections. Radiographs are shown in Figure A. What is the most appropriate next step in treatment?
Placement of epidural spinal stimulator
Lumbar decompression alone
Lumbar decompression with L5 to S1 posterior lumbar fusion
Lumbar decompression, L4 to S1 posterior lumbar fusion, and anterior column support
Minimally invasive direct lateral interbody fusion with percutaneous pedicle screw placement
HPI - The patient presents with severe bilateral buttock pain that makes it difficult for her to walk. She is comfortable when sitting, but can not stand upright due to the pain radiating into her buttocks and posterior thighs.
HPI - fell from a height years ago, neglected till pain became worse ,morning stiffness started one year ago ,pain now is uncontrollable with NSAID. also she took lots of muscle relaxants but, improvement was temporary and very little
patient own words"while walking", i feel a click on my lower back, like friction of 2 objects".
-pain has been felt for one year now
-she is a house wife with 3kids, she has a lot of work to do every day with no help.
How would you treat this Grade 1 adult isthmic spondylolithesis with back pain only, and a negative neurologic exam.