Bilateral transforaminal lumbar interbody fusion and L5-S1 transpedicular instrumentation by modified Wiltse approach
Keywords:
transforaminal lumbar interbody fusion, spondylolisthesis, transpedicular instrumentation, Wiltse approachAbstract
Objective: To describe the diagnostic and therapeutic process of a patient with Meyerding II isthmic spondylolisthesis that underwent transforaminal fusion and interbody vertebral instrumentation.
Clinical case report: We report the clinical case and the investigations carried out on an elderly adult patient, who attended the Neurosurgery department at Dr. Ernesto Guevara de la Serna General Teaching Hospital. His clinical-imaging condition showed moderate compressive radiculopathy at right L5, positive extension maneuvers of both legs and L5-S1 step secondary to Meyerding II L5-S1 isthmic spondylolisthesis. Bilateral transforaminal lumbar interbody fusion and L5-S1 transpedicular instrumentation were performed using modified Wiltse approach. Satisfactory control of symptoms and signs was achieved in the postoperative period.
Conclusions: The use of the modified Wiltse intermuscular technique reduced muscle dissection and retraction. Combining a lordotic intersomatic device, prepared with polymethylmethacrylate at our institution itself, made it possible to remodel the lumbosacral alignment and reduce costs. Bilateral transforaminal lumbar interbody fusion, using a minimally invasive technique, offered satisfactory results in low-grade lumbosacral spondylolisthesis.
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