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. 2016 Jun 10;8(6):e637. doi: 10.7759/cureus.637

Figure 3. Case example of a 54-year-old woman with disabling low back and leg pain in whom nonsurgical therapy had failed.

Figure 3

A: Preoperative sagittal T2-weighted MR image reveals a Grade I spondylolisthesis of L4-5 with a large L3-4 disc herniation. B: Preoperative axial T2-weighted MR image through the L4-5 disc space reveals bilateral facet disruption. It was elected to perform an L4-5 arthrodesis and L3-4 dynamic stabilization procedure. C: A postoperative lateral radiograph demonstrating the hybrid construct with a dynamically stabilized segment (L3-4) above a rigid fused segment (L5-S1). An interbody spacer was placed at L4-5. In all cases, a lordotic rod was implanted in order to preserve and/or restore normal lumbar lordosis. Every attempt was made when implanting the bumper to lock the patient into a lordotic posture. D: Postoperative AP radiograph demonstrating the DTO hybrid construct.