Diagnosis
Unstable Grade I isthmic spondylolisthesis at L5. Bilateral lumbalgia and ischialgia (lower back pain radiating to both legs). Status post-spinal surgery.
Patient:
Female, 18 years old, Russia
Physician:
Prof. Dr. med. Martin Scholz, Chief Physician, Department of Neurosurgery, Duisburg Clinic
Patient’s Complaints:
Lower back pain radiating down the posterior aspect of both thighs and lower legs.
Expert Opinion by Neurosurgeon Prof. Martin Scholz:
This is a complex case. It is highly unusual for a patient so young to have already undergone multiple surgical procedures involving spinal instrumentation.
I would strongly advise a comprehensive evaluation in our department. It is quite possible that we are dealing with a complex bilateral sacroiliac joint (SI joint) dysfunction, as the L5–S1 segment and the adjacent spinal region are now fused and immobile. Although there are no signs of spinal cord or root compression on the provided MRI scans, nerve compression is not a prerequisite for severe, chronic lumbalgia.
In this situation, I recommend a structured, multi-step diagnostic and therapeutic evaluation:
- Detailed neurological examination
- Comprehensive laboratory diagnostics
- Interdisciplinary pain therapy consultation
- Evaluation of tailored physical therapy options
- Targeted MRI of the lumbar spine
CT-guided diagnostic and therapeutic sacroiliac (SI) joint blocks, followed by thermal radiofrequency ablation (including endoscopic radiofrequency neurotomy) if indicated
If this diagnostic pathway demonstrates that the SI joint is not the underlying source of pain, we will need to consider re-evaluating the previous hardware, potentially removing pedicle screws at one level while utilizing bone grafting and temporary external brace stabilization.
Estimated Cost of Diagnostic Evaluation: €10,000