Anterior Interbody Fusion for Severe Spondylosis and Stenosis

Clinical Presentation and Diagnostic Findings

The patient presents with chronic, progressive, debilitating back pain that radiates into the buttocks consistent with S1 radiculopathy and L5, which has failed conservative management including physical therapy, activity modifications, and anti-inflammatories 3
MRI shows multiple disc desiccations with severe spondylosis at L5-S1 with foraminal narrowing bilaterally 4
The patient demonstrates positive straight leg raise test for back pain, indicating nerve root involvement 3
The patient's condition has significantly impacted quality of life, preventing her from working and caring for her family member 3

Guidelines strongly recommend surgical decompression and fusion as an effective treatment for symptomatic stenosis associated with degenerative changes in patients who desire surgical treatment (Grade B recommendation) 4
The preponderance of medical evidence favors the use of lumbar fusion following decompression in patients with stenosis and spondylosis, particularly in those patients who require more extensive decompression 1, 2
Multiple studies demonstrate that patients treated with decompression and fusion report higher incidence of good or excellent outcomes compared to decompression alone 3

The potential addition of posterior fixation and screws at L5-S1 is supported by evidence showing that pedicle screw fixation improves fusion success rates 1, 2
While fusion procedures carry risks including pseudarthrosis, hardware failure, and adjacent segment disease, these risks are outweighed by the potential benefits in this patient with severe, progressive symptoms that have failed conservative management 4
The patient has already had a successful anterior cervical fusion (ACDF) in the past with positive results, suggesting she may respond well to a similar approach in the lumbar spine 3