SpineUniverse Case Study Library

Progressive Pseudoclaudication in an Elderly Man


The patient is a 72-year-old man with no medical co-morbidities. He presented with progressive pseudoclaudication over several years. Now, he's able to walk only 100 yards. There is no bowel/bladder dysfunction. Bilateral L3 radiculopathy was confirmed with EMG.


He is neurologically intact in all lower extremity motor groups.

  • Sensation grossly intact
  • Absent reflexes
  • Good pulses
  • ODI: 48
  • VAS: Leg 7
  • VAS: Back 5

Prior Treatment

Selective L3 nerve root injection offered temporary relief of pain. Three epidural steroid injections and organized physical therapy provided no relief of pain.

Pre-treatment Images

Severe central stenosis noted at L2-L3, L3-L4, L4-L5.  Slight spondylolisthesis at L3-L4.Severe central stenosis noted at L2-L3, L3-L4, L4-L5. Slight spondylolisthesis at L3-L4.

Lumbar foraminal stenosis at multiple levelsForaminal stenosis at multiple levels

Coronal MRI shows mild scoliosis (right-bender)Coronal MRI shows mild scoliosis (right-bender)

axial L2-L3Axial L2-L3

L3-L4 showing subluxation at right L3-L4 facet joint; severe stenosisL3-L4 showing subluxation at right L3-L4 facet joint; severe stenosis

axial L4-L5Axial L4-L5


Multiple level lumbar spinal stenosis, L3-L4 degenerative spondylolisthesis, mild degenerative scoliosis

Suggest Treatment

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Selected Treatment

Minimally invasive multiple level laminoforaminotomies with minimally invasive TLIF at L3-L4.

Post-treatment Images





The patient is doing great at 2 years post-op.

  • ODI:16
  • VAS: Leg 0
  • VAS: Back 3

Case Discussion

This gentleman presents with textbook neurogenic claudication. He's been treated appropriately with non-operative management and continues to have symptoms affecting his quality of life. Selective nerve root injections and EMG nerve conduction study confirmed single-level radiculopathy.

There appears to be a mild degenerative scoliosis by MRI, but the lack of 3-foot AP and lateral x-rays make it difficult to determine spinal balance.

The post-operative x-rays do show that a one-level anterior/posterior procedure was performed at L3-L4. This has resulted in a clinical success according to the patient's VAS, which went from 7 to 0 for leg pain and 5 to 3 for back pain.

It is difficult to determine whether there has been progression of the deformity without pre-operative x-rays for comparison. It does appear from a clinical standpoint that the procedure was successful and by performing a minimally access surgery, there hasn't been significant disruption of the posterior elements that could lead to progression of the deformity.

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