Diagnosis
Degenerative lumbar spondylolisthesis at L4-L5 with foraminal stenosis and left-sided neurologic deficit.
Procedure and level
Left-sided UBE-TLIF at L4-L5. L4-L5.
Surgical levels and level count
- Treated levels
- 1 level
- L4-L5
- Decompression
- 1 level
- L4-L5
- New fusion
- 1 level
- L4-L5
Decompression and fusion at the same segment count as one treated level.
One level means one treated motion segment, such as L4-L5. Decompression and fusion can overlap; their counts are not added. Counts follow the source description and have not been re-audited against private charts.
Clinical presentation
The patient presented with severe left leg pain, gait disturbance, and left foot drop. The clinical symptoms were associated with sensory disturbance in the left L4-L5 dermatome and motor weakness involving ankle dorsiflexion and great toe dorsiflexion.
Neurologic findings
Preoperative neurologic examination demonstrated left ankle dorsiflexion weakness, approximately grade 3, and left great toe dorsiflexion weakness, approximately grade 3. Sensory disturbance was documented in the left L4-L5 dermatome. Gait disturbance was clinically significant.
Prior nonoperative treatment
Not reported in the available educational summary.
Imaging and clinical concordance
Preoperative lumbar radiographs and MRI demonstrated L4-L5 degenerative spondylolisthesis with foraminal stenosis and neural compression concordant with the patient's left-sided radicular symptoms, sensory disturbance, and foot drop. Dynamic radiographs were reviewed as part of the instability assessment.
Reasoning recorded for the procedure
The case was considered for fusion because the symptomatic level showed degenerative spondylolisthesis, foraminal stenosis, and neurologic deficit. The surgical objective was to decompress the affected neural structures and stabilize the L4-L5 segment.
Operative considerations
A left-sided UBE-TLIF was performed at L4-L5. The procedure included endoscopic decompression, disc space preparation, interbody fusion, cage placement, and posterior fixation. The operative workflow emphasized clear surgical targeting, efficient decompression, neural protection, and stabilization of the symptomatic segment.
Postoperative course
Postoperative neurologic follow-up documented improvement of the left-sided motor deficit from approximately grade 3 to grade 4+. This postoperative course is presented as an observation from this de-identified case only and should not be interpreted as predicting similar recovery in other patients.
Postoperative imaging
Postoperative radiographs demonstrated L4-L5 interbody fusion and posterior fixation. Postoperative MRI demonstrated decompression at the operated level.
Educational point
This case illustrates surgical decision-making in degenerative spondylolisthesis with foraminal stenosis and objective neurologic deficit. In UBE-TLIF, the rationale for fusion should be established first, based on instability, foraminal stenosis, neural compression, and neurologic findings. When fusion is performed in a spinal anesthesia environment, efficient operative workflow, precise surgical targeting, and reduction of unnecessary operative time may be important technical considerations. This should be presented as a technical teaching point rather than a general claim that all fusion surgery should be performed under spinal anesthesia.
Published images and video
Media are identified by their public source. Journal figures open at the original source; operative video illustrates a technical example. Imaging and operative appearances do not measure pain relief, function, or durable fusion.
Clinical history
preoperative imaging
postoperative imaging
Reported observations and missing data
Values below are limited to what the identified public source reports; source charts were not re-audited for this website update. Operative-time definitions and observation windows may differ. Do not compare these values across surgeons or procedures.
- Operative time
- 45 minutes.
- Estimated blood loss
- Approximately 200 mL.
- Hospital stay
- 4 days.
- Complications
- No perioperative complication was documented in this educational case summary.
- Follow-up interval
- Not reported in the available educational summary.
- Validated patient-reported outcome scores
- Not reported in the available educational summary.
Evidence and further reading
These sources provide clinical context. They are separate from the source records for this case and do not verify its outcome.
External evidence · randomized trial
Decompression alone or with fusion for degenerative lumbar spondylolisthesis (Nordsten-DS): five year follow-upKgomotso EL et al. BMJ. 2024;386:e079771.
At five years, decompression alone was non-inferior to decompression with instrumented fusion in the trial population.
Applicability: Patient selection and exclusions matter. These findings do not establish that every slip needs fusion, nor compare UBE-TLIF with all alternative techniques.
Source, authorship, and limitations
Source material: Hanjin Jang, MD academic case collection. Case 02 in the previously published Case-Based Education collection by Hanjin Jang, MD. A separate case-level clinical review date and public consent record are not reported in the available source. This entry was organized on 2026-09-11; this date records a website update, not a new clinical review.
Selection is educational. No population denominator, consecutive recruitment process, comparative group, or complete follow-up dataset is supplied. A missing complication field does not mean that no complication occurred. Published observations do not predict another patient's outcome.
No new private patient files were added in this update. Corrections and future clinical additions follow the editorial policy.
Suggested citation: Hanjin Jang, MD academic case collection. UBE-TLIF for Degenerative Spondylolisthesis With Foot Drop. Casebank, Case 02. Updated 2026-09-11. https://www.hanjinjangspine1.com/casebank/spondylolisthesis-foot-drop-ube-tlif