Question: Dear Dr.

This is Dr. XXXXXXX and I have a case with me for Lumbar disc disorder for whom I request your expert opinion for the treatment that is in the best interest of my patient.

Presenting complains:

This 58 years old male member presented with complains of localized back pain severe and left sided buttock pain and short sciatica for quite long.

Clinical Examination:

His lumbar spine does not show any malalignment.
There is persistent localized severe back pain, left-sided buttock pain, and left leg pain.
Axial rotation, retroflexion also forward bending is pain provocative.
There is no rotation as a sign of scoliosis.
Neurological examination shows left-sided buttock pain, sciatica, and radicular pain L5 left.
There is no weakness in the lower limbs. There is no any rotation as a sign of scoliosis.
SI joint provocation is negative.
Reflexes are normal.

Radiological Investigations:

X-ray LS standing position:
In flexion and extension shows symptomatic disc disease L5-S1 retrolisthesis XXXXXXX
CT ScanLS Spine:
Spondylolysis L5 left-sided. MRI shows dehydrated bulge disc at the
level LS-S1, and adjacent segment disease L4-L5
MRI LS Spine:
L5-S1 diffuse annular disc herniation.
L4-LS posterior disc bulge.
Degenerative LS-Sl bone marrow changes

Diagnosis:

Retrolisthesis L5-S 1 based on spondylolysis L5, adjacent segment disease L4-L5, and foraminal stenosis.

Proposed treatment plan:

L5-S1 fusion by AxiaLIF which is per coccygeal AUF L4-L5 interspinous spacer implantation.

Request:
It is requested to kindly give us your expert opinion if the treatment offered is optimum, as per the international neurosurgical guidelines and is in best interest of our patient.

I have also attached CT Scan report for your kind reference.

waiting for your kind feed back.