A 40-year-old man is diagnosed with degenerative spondylolisthesis at L4-L5 with lumbar spinal stenosis. He has neurogenic claudication refractory to 4 months of conservative management. MRI confirms facet joint hypertrophy and ligamentum flavum thickening causing central stenosis. What is the most appropriate surgical procedure?

• A Laminectomy alone
• B Anterior lumbar interbody fusion (ALIF) without decompression
• C Lumbar microdiscectomy
• D Laminectomy with instrumented posterolateral fusion ✓

Explanation

Degenerative spondylolisthesis with stenosis causing neurogenic claudication is treated with decompressive laminectomy and instrumented posterolateral fusion. The spondylolisthesis creates instability that warrants fusion to prevent further slip. Laminectomy alone risks progressive instability and slip. Microdiscectomy addresses disc herniation, not stenosis from facet/ligament hypertrophy. ALIF without decompression does not address the posterior element pathology causing the stenosis.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

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Written and medically reviewed by the StethoPrep medical team.