CASE REPORT
Minimally Invasive Transforaminal Lumbar Interbody Fusion
Minimally Invasive Transforaminal Lumbar Interbody Fusion
Correction of Grade 2 L5–S1 spondylolisthesis with a kyphotic lumbosacral segment, maintained at four-year follow-up
Grade 2
L5–S1 spondylolisthesis at presentation
23°
Segmental lordosis achieved intraoperatively
MIS TLIF
Minimally invasive transforaminal lumbar interbody fusion performed
4 years
Follow-up with maintained correction
Clinical history
The patient presented with Grade 2 spondylolisthesis at the L5–S1 level, associated with a kyphotic lumbosacral segment. This combination of forward vertebral slippage and abnormal sagittal angulation at the lumbosacral junction resulted in significant spinal instability. Given the degree of listhesis and the loss of normal lordotic alignment, surgical correction was indicated to restore stability and sagittal balance to the lumbosacral spine.
Radiological evaluation confirmed Grade 2 L5–S1 spondylolisthesis with a kyphotic lumbosacral segment, establishing the need for reduction and instrumented fusion to restore stability.
Dr. Rohit Thaker performed a Minimally Invasive Transforaminal Lumbar Interbody Fusion (MIS TLIF), accessing the L5–S1 segment through a muscle-sparing corridor to limit surgical trauma.
The listhesis was completely reduced and sagittal alignment restored, with 23° of segmental lordosis achieved intraoperatively at the L5–S1 level.
Stable instrumented fixation was achieved entirely through the minimally invasive approach, providing a solid construct to support fusion while preserving surrounding soft tissue.
Outcome
At four-year follow-up, the correction remains well maintained with excellent radiological alignment and a solid construct — the patient is completely symptom-free, back to normal daily activities, and doing exceptionally well both clinically and radiologically.
Cause and clinical significance
Spondylolisthesis at the L5–S1 level occurs when the fifth lumbar vertebra slips forward relative to the sacrum, most often due to a pars interarticularis defect (isthmic spondylolisthesis) or degenerative changes in the disc and facet joints. When this slippage is accompanied by a kyphotic, rather than the normal lordotic, alignment of the lumbosacral segment, the spine loses much of its mechanical stability and sagittal balance, which can drive pain and progressive deformity if uncorrected. Restoring segmental lordosis and achieving a stable, well-fused construct — as achieved here with the minimally invasive transforaminal lumbar interbody fusion approach — is central to re-establishing normal load distribution across the lumbosacral spine and preventing recurrence of instability.