The Center is dedicated to fostering an understanding between health care professionals and people of Hispanic origin for the purpose of increasing understanding of health and healing through research of individual experience, cultural meanings, and the structure of institutions as important variables influencing health outcomes. The Center is also committed to the provision of educational programs and services which will assist health care providers to gain the necessary knowledge and skills to deliver increasingly culturally sensitive and competent care. The Center promotes interdisciplinary and interuniversity collaboration as a strategy for development of resources to solve or deal with bi-cultural issues facing health care professionals.
The clinical situation is consistent with neurogenic claudication due to degenerative spondylolithesis at L4/5. Decompression with a laminectomy and instrumented fusion is the most appropriate treatment.
Weinstein et al performed a randomized and observational cohort study comparing standard decompressive laminectomy (with or without fusion) to nonsurgical care for the treatment of degenerative spondylolithesis. They found patients treated surgically maintain substantially greater pain relief and improvement in function for four years.
Herkowitz et al prospectively studied 50 patients with degenerative spondylolithesis to determine if concomitant intertransverse-process arthrodesis provided better results than decompressive laminectomy alone. They found that the arthrodesis group had significantly better results with respect to relief of pain in the back and lower limbs at an average follow-up of 3 years.
Fischgrund et al shows that in patients undergoing single-level posterolateral fusion for degenerative spondylolisthesis with spinal stenosis, the use of pedicle screws leads to a higher fusion rate.
Answer 1: The patient has failed nonoperative management and her symptoms are affecting her quality of life. In addition, he has neurologic deficits, so operative treatment is indicated.
Answer 2: Posterior decompression alone for the treatment of mobile degenerative spondylolisthesis (DS) can lead to iatrogenic instability, and is not appropriate.
Answer 3: The patient's neurogenic claudication is caused by spinal stenosis, and a microdiskectomy would not address this.
Answer 5: An ALIF would not adequately decompress the spinal canal and is not the most appropriate treatment.
Springer has partnered with Copyright Clearance Center's RightsLink service to offer a variety of options for reusing Springer content. For permission to reuse our content please locate the material that you wish to use on or on and click on the permissions link or go to , then enter the title of the publication that you wish to use. For assistance in placing a permission request, Copyright Clearance Center can be connected directly via phone: +1-855-239-3415, fax: +1-978-646-8600, or e-mail: [email protected]