Degenerative Disc Disease L4-L5 Dr. med. Jérôme Delambre
Clinical Case – DDD – Revision Surgery
Dr. med. Jérôme Delambre
Institut du Rachis parisien
45-year-old female patient
No medical history
Patient is suffering from chronic pain of disabling bilateral lumbosciatica in level L4-L5, disc arthrosis L4-L5. Bilateral spondylolysis with intersomatic pinching, and complicated by a grade I anterolisthesis.
This patient was treated surgically in 2018 with flexible osteosynthesis without release of the L4-L5 channel, which did not relieve her pain symptoms.
Pre OP radiographs
Severe L4-L5 intersomatic pinching can be observed in radiographs with moderate instabilities on dynamic images.
MRI confirms DDD with Modic T2 L4-L5 reaction
CT scans confirm the disc arthrosis as well as the bilateral spondylolysis L4-L5 with pedicle screws well positioned in L4-L5
The painful lumbar situation can be explained by the L4-L5 disc involvement, instability due to spondylolysis
The nerve root pain can be explained by foraminal closure linked to the loss of disc height
Circumferential fusion correction, L4-L5, will be proposed in order to restore the distal height as well as the spondylolisthesis
This intervention is offered in 3 steps:
Removal of implant material with bilateral arthrectomy and bilateral isthmectomy
Correction of anterolateral fusion by an interbody fusion cage
Instrumented arthrodesis L4-L5 using the Neo Pedicle Screw System™
Implant material to be removed
Neo pedicle markers placed
Interbody fusion cage; lateral LLIF approach and placement of an Avenue® L Lateral Lumbar Cage.