Paresis of the L5 nerve root after reduction of low-grade lumbosacral dysplastic spondylolisthesis: a case report.

We present a unique case of a 16-year-old patient who underwent lumbar decompression surgery (L4-S1), low-grade spondylolisthesis reduction surgery at L5-S1, and posterior instrumented fusion from L4 to the pelvis. Neurologic monitoring did not show any sustained changes throughout the operation. The patient was awoken from endotracheal anesthesia with grade 0 muscle function of the left extensor hallucis longus and tibialis anterior muscles resulting in left-sided foot drop. At the last follow-up 12 months after surgery, the patient had partial recovery, with grade 4 muscle function of the left extensor hallucis longus and tibialis anterior muscles. We suggest that early identification with direct nerve root stimulation and wake-up test immediately after reduction of spondylolisthesis will allow prompt release of the reduction and further foramen exploration, and increase the possibility of good postoperative nerve root recovery.