Clinical Course
67 year old female with pain in both legs walking and standing with the pain in the front of both thighs and into the shins. She did not complain of weakness or numbness in the legs but could not walk or stand more than 10 minutes without severe leg pain.

Diagnostic Tests
Xrays revealed spondylolisthesis. An MRI scan demonstrated spinal stenosis and degenerative spondylolisthesis.

Decision
The patient had tried conservative care without benefit and had leg pain for 8 months. A lumbar decompression (removal of the spinal roof compressing the nerves) and fusion at the level of the spondylolisthesis was recommended. Not every patient will have a spine fusion with a spondylolisthesis but the vast majority will.

Surgical Treatment
Lumbar laminectomy and fusion.

Surgeon's Comment
The trend in surgery for spinal stenosis with spondylolisthesis is to perform a lumbar laminectomy and fusion. The addition of instrumentation is believed to enhance the fusion rate. As people mature,the strength of the bone to support instrumentation is sometimes an issue. In this instance, a fusion was performed without instrumenation. At last follow-up 2 years after her surgery, she had no back or leg pain.