CASE REPORT
Minimally Invasive TLIF for Two-Level Lumbar Spondylolisthesis
Minimally Invasive TLIF for Two-Level Lumbar Spondylolisthesis
Two-level minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) performed for L4–L5 and L5–S1 spondylolisthesis causing severe bilateral nerve compression.
Age
60-year-old patient
L4–L5 & L5–S1
Two-level lumbar spondylolisthesis
MIS TLIF
Minimally invasive spinal fusion performed
Early Recovery
Comfortable walking from the day after surgery
Clinical history
Mr. Jyotindrabhai Swaminarayan, a 60-year-old resident of Ahmedabad, presented with a six-month history of lower back pain accompanied by pain radiating into both legs. Walking had gradually become increasingly difficult because of the severity of the leg pain. During the three weeks before consultation, his lower back pain worsened considerably, affecting routine daily activities and limiting his mobility.
After a detailed assessment, surgical treatment was considered the most appropriate option to relieve the ongoing nerve compression and restore spinal stability.
Clinical examination, MRI, and X-ray imaging demonstrated spondylolisthesis at both the L4–L5 and L5–S1 levels. The forward displacement of the vertebrae had narrowed the spaces around the nerve roots, producing significant bilateral nerve compression that correlated with the patient's symptoms.
The presence of two-level instability and persistent neurological symptoms supported the decision to proceed with surgical management.
Dr. Rohit Thaker performed a minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) using a keyhole approach. Through small incisions, the affected spinal levels were accessed while minimising disruption to the surrounding muscles and soft tissues.
This approach allowed treatment of both spinal instability and nerve compression without the extensive tissue exposure associated with conventional open surgery.
During the procedure, the compressed nerve roots at the L4–L5 and L5–S1 levels were carefully decompressed. The slipped vertebrae were restored to improved alignment, and both spinal segments were stabilised using interbody fusion and instrumentation to provide lasting mechanical support.
Adequate decompression and stable fixation were achieved at both levels before completion of the procedure.
The patient recovered smoothly following surgery and was encouraged to begin walking early during the post-operative period. By the following day, he experienced significant relief from his leg pain and was able to walk comfortably. Recovery continued steadily, allowing a gradual return to everyday activities.
Outcome
Following surgery, the patient’s symptoms resolved completely. The patient is pain-free, neurologically stable, and continues to do well on clinical follow-up after successful removal of the migrated disc fragment.
Cause and clinical significance
Sequestered lumbar disc herniations occur when a fragment of the intervertebral disc separates completely from the parent disc and migrates away from its original position. Cranial migration at the L1–L2 level is uncommon and can occasionally resemble a neurogenic tumour on MRI because of its location and imaging characteristics. Accurate interpretation of clinical findings together with imaging is therefore essential to establish the correct diagnosis.
Micro endoscopic discectomy provides an effective option for treating selected cases of migrated lumbar disc herniation. Through a small tubular corridor, the offending disc fragment can be removed while preserving healthy tissues, achieving effective neural decompression and supporting a quicker functional recovery.