Shown above are MRI images of a patient presenting with incapacitating low back and leg pain. Mild multi-level degenerative changes consistent with an underlying genomic spine condition are present in addition to a G1 degenerative spondylolisthesis (red dot). This listhesis is producing a central spinal stenosis (center image). In addition there is discal bulge into the left intervertebral foramen (A), a discal herniation into the foramen at L4-5 with resulting lateral spinal stenosis (B), and lateral spinal stenosis at L5-S1 secondary to a superior articular facet syndrome (C).
As the method of surgical treatment a Dynesys flexible stabilization system was placed from L4 to L5 levels. The image to the right shows that no decompression of stenosis was performed.
This patient was not improved following placement of flexible stabilization system. It was removed and then replaced with a rigid segmental instrumentation system as shown. There has also been a laminectomy at the L4, but not the L5 level. The patient has continued to have significant problems.
The case presented was a treatment failure. The reason for this was not related to the employment of a flexible stabilization but upon failure to address the primary need for adequate nerve decompression prior to considering any form of stabilization. Another example of the relationship between a carpenter and a nail.