The patient is a 64 year old female with severe buttock pain when she walks greater than 2-3 minutes. In addition, she experiences low back pain during even minimal lifting or bending activities. Her lumbar radiographs (Images A & B) show the slippage of L4 relative to L5. L4-5 is the most commonly affected level with degenerative spondylolisthesis.
The MRI scan reveals severe spinal stenosis at L4-5, and relatively normal canal at the adjacent levels (Images C & D).
Note the severe stenosis at L4-5 in red (Images E & F), and the normal canal at L3-4 in blue (Images E & G)
She underwent L4-5 laminectomy and fusion with instrumentation (Image H). Usually, interbody fusion is unnecessary.
