PMC5482161_01
(a) T2-weighed sagittal MRI showing a L5-S1 spondyloptosis. (b) Plain lateral X-ray demonstrating pullout of the sacral screws and cage migration into the spinal canal following the first lumbopelvic fixation. (c) Plain lateral X-ray demonstrating pullout of the S1 and S2 screws with loss of correction and spondyloptosis after the second lombopelvic fixation
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F1
A.P.L.S, a 31-year-old female presented with progressive severe back/buttocks pain, tenesmus, urinary incontinence, nocturnal enuresis, bilateral foot drop and plantar flexion weakness (strength II out of V) related to a spondyloptosis [Figure 1a]. At the age of 29, she had an L4-S1 posterior fusion with anterior column support that resulted in pullout of the sacral screws and cage migration [Figure 1b]. The third operation, at the age of 30, required a posterior L4-S2 instrumented revision, also failed resulting in pullout of the sacral screws and slip recurrence [Figure 1c].
(a-e) Imaging studies demonstrating reduction of the slip to a grade II and adequate placement of the iliac screws
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F2
Postoperative imaging studies demonstrated reduction of the slip to a grade II and excellent placement of the iliac screws [Figure 2].
Follow-up imaging studies demonstrating a solid fusion across the lumbosacral junction
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F3
A robust fusion mass across the lumbosacral junction was documented in the follow-up CT scans [Figure 3].