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Journal of Case Reports
3-Level Degenerative Spondylolisthesis with Spinal Canal Stenosis

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Moo Ing How1, Tan See Wei2, Kasat  Niraj1, Thng Leong Keng1
From the Department of Orthopaedics Surgery, Changi General Hospital, Singapore1 and University Malaya Medical Centre, Malaysia2.
Corresponding Author:
Dr. Ing How Moo
Email: zell53@hotmail.com
Received: 07-JUN-2014 Accepted: 24-JUN-2014 Published Online: 20-JUL-2014
DOI: http://dx.doi.org/10.17659/01.2014.0065
Abstract
Introduction: Lumbar degenerative spondylolisthesis is a major cause of impaired quality of life and diminished functional capacity in the elderly. Degenerative spondylolisthesis often involves only one or two level and tend to present with one or two level spinal canal stenosis. Case Report: The authors describe an unusual case of degenerative spondylolisthesis involving 3 levels of the lumbar spine from L2 to L5. The patient was a 58 year old woman who suffered chronic back pain and neurogenic claudication.  Plain radiography revealed grade I degenerative spondylolisthesis at L2-L3, L3-L4 and L4-L5. Elevated pedicle-facet joint angles and W-type facet joints at the lumbar spine was observed. Magnetic resonance imaging showed L2-S1 spinal cord compression at the lumbar spine. Patient underwent L2-S1 decompression laminectomy and posterior lateral fusion of L2-S1 with posterior instrumentation and bone grafting. Symptoms improved significantly at 4 months follow-up.  Conclusion: Thorough evaluation for multilevel segmental involvement in degenerative spondylolisthesis is important because of the frequency of severe symptomatic spinal stenosis or foraminal encroachment. Good surgical outcome can be expected from decompression and stabilization. The pathogenesis of multi-level lumbar degenerative spondylolisthesis can be complex and heterogeneous. 
Keywords : Spondylolisthesis, Spinal stenosis, Lumbar Vertebrae, Spinal cord compression, Lumbosacral Region.
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