Lytic Spondylolisthesis
Four pedicle screws accurately placed under Bolt guidance in a patient with grade III lytic spondylolisthesis — trajectory validated head-to-head against an O-arm Stealth Station.
Patient Overview
Age
65 years old
Sex
Female
Diagnosis
Lytic spondylolisthesis, L4-5, grade III
Surgery Details
Procedure
L4-5 fusion with pedicle screw fixation and decompression, repositioning L4 to L5 — performed as a head-to-head comparison against an O-arm Stealth Station (Medtronic)
Levels with fixation
L4-5
Fixation type
Pedicle screw fixation
Posterior approach: decompression of the L4 nerve roots and reduction of L4 to L5.
75 minutes
Surgical time
200 cc
Blood loss
Operative Workflow
The patient was positioned prone, prepped and draped per standard procedure. Axial images of L4 and L5 were acquired with the Bolt Navigation System using the patient's pre-operative CT scans. A standard C-arm was used to obtain a true-lateral image of these levels, which was then acquired with the BNS.
An open approach was used to expose the levels and perform decompression. The BNS was attached to a Medtronic gearshift probe to determine the correct trajectory for the screw pilot holes. The trajectory was checked intraoperatively against an O-arm Stealth Station to compare accuracy. The BNS was then used to generate the pilot hole, which was tapped and the screws placed. All four screws were positioned in the middle of the pedicles in L4 and L5 — the Bolt telemetry matched the O-arm Stealth Station in every case. Final screw positioning was confirmed by post-operative CT.
Pre-op
Imaging of the grade III lytic spondylolisthesis at L4-5.
Peri-op — Bolt head-to-head with an O-arm Stealth Station
Bolt on the gearshift probe over the exposed L4-5 level, run alongside the O-arm Stealth Station; the Bolt bullseye confirms the screw trajectory.
Post-op
X-rays confirming the four L4-5 pedicle screws accurately placed in challenging anatomy.
Results
All four screws were placed accurately in challenging anatomy, and the Bolt telemetry matched the O-arm Stealth Station on every screw. The patient's leg pain resolved completely, with minimal residual back pain.
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