Grade 4 spondylolisthesis. Two-stage therapeutic approach of anterior vertebrectomy and anterior-posterior fusion.

The authors present the case of a 23-year-old white woman gymnast with a nine-month history of severe low back pain, spasm and radiation of pain into the buttocks. When back pain had first begun, she was diagnosed elsewhere as having spondylolisthesis, grade unknown. She was started on conservative therapy which included bracing, flexion exercise, and anti-inflammatory and analgesic medication. There were periods of improvement followed by periods of relapse until two months prior to being seen by the authors, when back pain and spasm became constant. Physical examination and x-rays now revealed a Grade 4 spondylolisthesis with a spastic scoliosis from T-3 to T-6 (left) of 18 degrees and T-11 to L-2 (right) of 25 degrees. Surgery was decided on and the authors describe the surgical procedure, a combined anterior-posterior two-stage approach of anterior vertebrectomy with anterior fusion, followed by posterior stabilization and fusion. The patient has experienced complete pain relief, a return of good strength and good posture and an overall improvement in function. The authors recommend the two-stage procedure for high grade spondylolisthesis.