Posterior lumbar interbody fusion (PLIF) combined with pars repair using a U-shaped rod technique for two-level lumbar spondylolysis: case report and technical note.

BACKGROUND

Multi-level lumber spondylolysis is a rare clinical condition. In a surgical case, a surgical strategy gets complicated and needs to be tailored to each. We report a case of L4 and L5 spondylolysis with L4-5 spondylolisthesis successfully treated using the U-shaped rod technique.

CASE DESCRIPTION: The patient experienced low back and right lower leg pain. Neurological imaging revealed L4-5 spondylolytic spondylolisthesis, resulting in right foraminal stenosis and L4 root compression. L5 spondylolysis without slipping was observed. We performed L4-5 posterior interbody fusion and L5 pars repair using a U-shaped rod; L4 and L5 bilateral pedicle screws were inserted and connected by a U-shaped rod hooked to the L5 spinous process. Post-surgery, L4-5 slip and L5 pars defects were reduced and stabilized, with improved neurological symptoms.

CONCLUSIONS

L4-5-S fusion was unnecessary for L5-S lesions without instability or foraminal stenosis. Simple fusion surgery had a subsequent negative effect on L5 spondylolysis. Therefore, we devised a fusion surgery and spondylolysis repair combination using a U-shaped rod that preserved L5-S mobility and L4-5 stability. The U-shaped rod technique is a surgical method for multilevel spondylolysis and is minimally invasive, readily available, simple, and effective. It is suitable for symptomatic proximal spondylolisthesis and asymptomatic distal spondylosis.