CASE REPORT
Minimally Invasive TLIF for L4–L5 Spondylolisthesis
Minimally Invasive TLIF for L4–L5 Spondylolisthesis
Keyhole minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) performed for L4–L5 spondylolisthesis causing severe nerve compression and disabling leg pain.
Age
60-year-old patient
L4–L5
Spondylolisthesis with nerve compression
MIS TLIF
Minimally invasive spinal fusion performed
Next-Day Walking
Independent mobilization after surgery
Clinical history
A 60-year-old patient from Ahmedabad presented with severe lower back pain accompanied by pain radiating into the leg. The symptoms had gradually worsened over several months and, in the days leading up to consultation, had progressed to the point where walking had become extremely difficult.
The severity of pain and reduced mobility significantly affected the patient’s ability to perform routine daily activities, prompting further evaluation.
Clinical examination and imaging demonstrated L4–L5 spondylolisthesis, commonly referred to as a slipped vertebra. The forward displacement of the vertebra had narrowed the space available for the nerve, resulting in significant compression of the nerve supplying the leg.
The patient's symptoms and imaging findings were consistent with mechanical instability accompanied by nerve root compression, making surgical treatment an appropriate option.
Dr. Rohit Thaker performed a minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) using a keyhole approach. Through a small incision, the affected spinal level was accessed while preserving the surrounding muscles and soft tissues as much as possible.
This approach enabled treatment of both the spinal instability and the compressed nerve through a minimally invasive corridor.
During the procedure, the compressed nerve was carefully decompressed to relieve pressure responsible for the patient's leg pain. The displaced L4 vertebra was restored to a more anatomical position, and the L4–L5 segment was stabilised with interbody fusion and instrumentation to provide long-term spinal stability.
Adequate decompression and stable fixation were achieved before completion of the procedure.
The patient had a smooth post-operative recovery and was encouraged to begin mobilising early. By the day after surgery, the patient was able to walk independently with marked improvement in leg pain. Recovery continued steadily, allowing a gradual return to normal daily activities.
Outcome
Following surgery, the patient’s leg pain improved significantly, and walking became comfortable once again. The patient regained independence in mobility and continues to recover well with a substantial improvement in daily function.
Cause and clinical significance
Lumbar spondylolisthesis occurs when one vertebra slips forward over the vertebra below it. This displacement may result from age-related degeneration of the spinal joints and discs, leading to instability and narrowing of the spaces through which the nerves travel. As compression progresses, patients commonly develop lower back pain, radiating leg pain, numbness, weakness, and increasing difficulty with standing or walking.
Minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) addresses both the instability and the nerve compression through a muscle-sparing approach. By restoring spinal alignment, decompressing the affected nerve, and stabilising the involved segment, the procedure aims to relieve symptoms while supporting early mobilisation and functional recovery.