case_images: PMC10899093_01
case_images: Upright AP (A), lateral (B), lateral flexion (C), and lateral extension (D) radiographs of the lumbar spine on presentation revealed intact Luque implants at L4-S1 with mobile Grade 1 degenerative anterolisthesis at L3-4. AP: anteroposterior
case_images: cureus-0016-00000053120-i01.jpg
case_images: PMC10899093_01_cureus-0016-00000053120-i01.jpg
case_images: FIG1
case_images: Radiographs revealed a previous L4-S1 posterolateral fusion with Luque instrumentation and mobile Grade 1 degenerative L3-4 anterolisthesis (Figure 1).
case_images: Advanced imaging findings on presentation. (A-B) Mid-sagittal T2-weighted MRI (A) as well as a corresponding axial cut through the L3-4 disc space (B) demonstrated adjacent segment degeneration with L3-4 canal stenosis. (C-E) Myelogram (C), mid-sagittal (D), and L3-4 axial (E) cuts from a subsequent CT with similar findings. (F) CT myelogram also confirmed successful L4-S1 posterolateral fusion, which can be appreciated in this coronal image. MRI: magnetic resonance imaging, CT: computed tomography
case_images: cureus-0016-00000053120-i02.jpg
case_images: PMC10899093_01_cureus-0016-00000053120-i02.jpg
case_images: FIG2
case_images: A lumbar spine MRI as well as a myelogram with subsequent CT were performed (Figure 2).
case_images: Intra-operative images. (A) View of the left L4 Luque pedicle screw head seen through the tubular retractor. (B) Explanted pedicle screws with corresponding removal driver. (C) Closed posterior incisions; the Wiltse incisions were used for L4 Luque pedicle screw explantation and extension of instrumented posterolateral fusion, and the midline incision was used for decompression. (D) Final dressings
case_images: cureus-0016-00000053120-i03.jpg
case_images: PMC10899093_01_cureus-0016-00000053120-i03.jpg
case_images: FIG3
case_images: The left L4 pedicle screw head was exposed (Figure 3A). A 7 mm female hexagonal driver from a universal hardware removal set was found to fit snugly over the screw head and used to remove this pedicle screw (Figure 3B). Rods were passed, final tightening performed, screw tabs were removed, and wounds were irrigated and closed (Figure 3C-3D).
case_images: (A-B) Intra-operative AP (A) and lateral (B) fluoroscopic images demonstrating the final construct. (C-D) Upright AP (C) and lateral (D) radiographs at one-year follow-up reveal intact implants without suggestion of loosening or failure. AP: anteroposterior
case_images: cureus-0016-00000053120-i04.jpg
case_images: PMC10899093_01_cureus-0016-00000053120-i04.jpg
case_images: FIG4
case_images: Final fluoroscopy shots demonstrated the completed construct (Figure 4A-4B). Post-operative radiographs revealed maintained implant placement without evidence of loosening, migration, subsidence, or failure (Figure 4C-4D).