Al-Azhar Neurosurgery

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info@alazharneurosurgery.com

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Al-Hussein university hospital , Al-Sayyed Galal hospital

+2 0102 9252247, +2 0111 1726597

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Case 16

Case 16 Spondylolithesis

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Figure 16.1: MRI sagittal T2 and x ray of the patient

  • Q1: According to the Meyerding classification, which grade of spondylolisthesis is shown on this lateral radiograph of the lumbar spine?
  • Grade 2
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Figure 16.2: Meyerding classification.

  • Q2: Degenerative spondylolisthesis is typically caused by: –
  1. Degenerative facet arthrosis.
  2. Disc degeneration.
  3. Pars interarticularis remodeling.
  4. Trauma.
  • The correct answer is Degenerative facet arthrosis.
  • Q3: What type of Modic changes are present here, and what are signal characteristics on MRI of the lumbar spine?
  • Modic type 1 (bone marrow oedema)
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Figure 16.3: Modic changes.

  • Q4: During surgery to this case which the nerve root needs to be decompressed?
  • The nerve roots of concern to be decompressed are the L4 and L5 roots. This differs from lumbar disc prolapse, where L4 is usually compressed by the slippage of the vertebrae, unlike lumbar disc prolapse, which typically compresses L5 away from the L4 foramen. Intraoperatively and after decompression, bilateral L4 and bilateral L5 roots need to be checked.
  • Q5: During transpedicular screw application, what is the direction of the screw insertion? Which structures are strong?
  • It is either aligned with the longitudinal direction of the pedicle or directed towards the superior end plate. The latter is preferable as it is stouter due to the stronger bone near the end plate.