Grade 1 Anterior Listhesis

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The severity of her symptoms has led her to exercise primary on a stationary bicycle, which she reports does not cause her symptoms.

On physical exam she is neurologically intact in her lower extremities. A flexion and extension radiograph is performed and shown in Figure A.

Sagittal and axial MRI images are shown in Figure C and D.

What is the next most appropriate step in mangement?

A 65-year-old male presents for postoperative follow up after undergoing spinal surgery.

His preoperative and postoperative radiographs are shown in Figure A and B respectively.

He has failed non-operative treatment and elects to undergo surgery.

Assuming he undergoes the appropriate surgery, which of the following places him at the highest risk for adjacent segment disease requiring future surgery?

Her symptoms are worse with walking and improve with sitting.

She now finds it difficult to walk even small distances, such as to her mailbox.

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