Minimal Invasive Transforaminal Lumbar Interbody Fusion for Isthmic Spondylolisthesis with Nerve Root Anomaly in Young Adult Male Football Player: Case Report

Abstract

Interbody fusion is preferred surgical treatment for various symptomatic pathologies of lumbar spine and spondylolisthesis is one of the commonest indication. Goal is to achieve adequate bony and neural decompression, disc height restoration, deformity correction and good interbody fusion. Numerous techniques and approaches have been designed, minimal invasive tubular transforminal interbody fusion is widely accepted among them. In any case pre-operative planning and identifying any anatomical variation is prerequisite before surgery. In this article, we report, 22-year male football player, presenting with worsening low back pain, left radicular pain with neurogenic claudication. Radiographs revealed a L5-S1 Meyerding grade I isthmic spondylolisthesis with L5-S1 left sub articular disc protrusion with narrowing of lateral recess on left side and no evidence of lumbosacral nerve root anomalies on magnetic resonance imaging. Patient was planned for minimal invasive L5-S1 transforaminal interbody fusion, intraoperatively, Type 3 Neidre and Macnab root anomaly was identified, patient successful underwent interbody fusion with no acute intraoperative or postoperative complications. In follow up period, patient had no radicular pain. In our article, we summarize the incidence, classification of nerve root anomaly along with intra operative strategy for interbody fusion in presence of root anomaly and report this rare twin anomaly. Keywords: Isthmic spondylolisthesis, nerve root anomaly, MIS TLIF, young football player.