Patient Name : Mrs. Nil
Age : 50 years
Introduction
This case discusses a 50-year-old woman suffering from L4–L5 disc prolapse with severe lumbar canal stenosis. She presented with chronic back pain, bilateral radiculopathy, numbness, and neurogenic claudication.
After evaluation at The Spine Doctor – Bavdhan, Pune, she underwent L4–L5 TLIF, resulting in reduction of leg pain, improved walking ability, and overall functional improvement.
Patient History & Presentation
The patient presented with:
- Back pain for 1 year
- Bilateral leg pain, worse on the left
- Tingling & numbness in both limbs
- Difficulty walking beyond 10 minutes
- Pain with sitting, standing, bending, bed turning
- Sleep disturbance
- Dorsiflexion weakness on right (2/5 pre-op)
- Slouch test positive bilaterally
These findings suggested radiculopathy, instability, and severe nerve compression.
Diagnosis & Radiology
X-ray Findings
- Hypertrophic transverse process LV5 (Castellvi type 1a)
- Grade 2 listhesis at L4–L5
- Preserved lumbar lordosis
MRI Findings
- Lumbar spondylosis
- Disc degeneration at L3–4 and L5–S1
- Severe L4–L5 disc protrusion with ligamentum flavum thickening
- Lateral recess narrowing
- Severe central canal stenosis
Lay Explanation
The disc had slipped and narrowed the spinal canal, compressing nerves responsible for pain, numbness, and leg weakness.
Surgical Procedure – L4–L5 TLIF
Performed under general anesthesia.
Steps:
- Decompression of nerve roots
- Removal of herniated disc
- Placement of interbody cage
- Pedicle screw fixation using Jayon implants
- Restoration of alignment and stability
People Also Ask:
Is TLIF safe?
Yes — TLIF is a standard and effective surgery for severe stenosis and listhesis.
How long is recovery?
Patients usually walk the next day and improve steadily.
Can TLIF relieve leg pain?
Yes, by decompressing compressed nerves.
Post-Operative Recovery
- Gradual reduction in pain
- Improvement in right dorsiflexion weakness
- Increased walking tolerance
- Better sleep
- Able to sit and stand with less discomfort
- Stable neurological status
Long-Term Outcome
Patients typically experience:
- Reduced leg pain and numbness
- Improved walking distance
- Improved dorsiflexion strength
- Better daily function
- High satisfaction and return to routine activities
This mirrors outcomes seen with Lumbar stenosis treatment Pune using MIS techniques.
Why Surgery Was Necessary
- Severe nerve compression
- Grade 2 listhesis
- Failure of conservative treatment
- Risk of worsening neurological deficit
- Mechanical instability at L4–L5
About Dr. Sangram Rajale
Dr. Rajale is a leading Spine Surgeon in Pune specializing in:
- TLIF / PLIF / OLIF
- Minimally invasive spine surgery
- Endoscopic spine procedures
- Sciatica and slipped disc management
He practices at The Spine Doctor – Bavdhan, offering evidence-based treatment.
FAQs
Leg pain, tingling, numbness, weakness, and back pain.
Patients walk within 24 hours and improve over weeks.
If symptoms persist or neurological weakness appears.