More than three decades ago, M.C., a 49-year-old living in Canada, underwent surgery for scoliosis. Over the past year, she had developed severe back pain that radiated down her right leg, forcing her to stop after walking 100 to 200 metres.
After being examined at several major hospitals in Canada and the United States, doctors determined that she had L4-L5 spondylolisthesis, causing spinal stenosis and nerve root compression.
Her case was considered complex because she still had an old spinal fixation system in place. With conventional treatment, the doctors would have had to remove the entire existing system and replace it with a new one.
After doctors explained the significant risks associated with such major surgery while the likelihood of success remained uncertain, M.C. hesitated to undergo the procedure. She continued searching for hope and eventually decided to travel halfway around the world to Vietnam, seeking treatment at FV Hospital.
After directly examining the patient, Dr Tran Luong Anh, specialist level II, head of Neuro-Surgery and Spine Surgery, said “After more than 30 years, the bone has healed and covers almost the entire plate-and-screw system. If we wanted to remove it, we would have to break through the healed bone, making the surgery extremely complex and risky.”
The situation was further complicated by a screw in the right side of the L4 vertebra that had broken long ago, with the fractured portion embedded deep within the vertebral body, leaving no room for placement of a new screw.
Before deciding on surgery, the FV team collaborated with the Pain Clinic to perform a nerve block to accurately identify the source of the pain.
The results showed that her symptoms were actually caused by spondylolisthesis and nerve compression. Because the pain relief provided by the nerve block lasted less than a month, surgery was considered the only optimal solution to preserve the patient’s mobility.
A novel treatment strategy from the FV team of experts
Recognising this as a rare case involving a unique anatomical structure, the FV medical team agreed on a novel treatment strategy: retaining the entire existing plate-and-screw system and adding a new fixation system only to the lower section, thereby minimising tissue damage to the patient. To carry out this plan, the hospital ordered specialised connecting components from overseas because they were not yet available on the domestic market.
The surgery was performed with the assistance of a navigation system. Photo: FV Hospital
To place new screws while avoiding the fractured screw lodged deep within the vertebral body, the surgical team used a navigation system.
Based on data from computed tomography images, the system reconstructed the spinal anatomy in 3D in real time, allowing the surgeons to accurately visualise and track the trajectory of the surgical instruments down to the millimetre throughout the procedure.
“Navigation helps us choose a safe trajectory for screw placement and avoid the fractured screw remaining inside the vertebral body. If the screw deviates by just a few millimetres, the patient may require revision surgery or experience impaired mobility,” Dr. Luong Anh said.
A typical surgery for spondylolisthesis takes approximately two hours. However, due to the rare complexity of this case, the procedure lasted longer than expected.
After more than three hours of surgery, the doctors successfully placed four new screws, replaced the artificial disc at the L4-L5 level, and decompressed the compressed nerve root.
Experts urge caution about persistent back pain
After surgery, the patient remained in the hospital for about a week and underwent physical therapy. Her pain gradually improved, and her mobility recovered well. One month after surgery, she was discharged from the hospital and returned to Canada.
The patient’s letter to Dr. Tran Luong Anh sent before returning home. Photo: FV Hospital
According to Dr. Luong Anh, people should not ignore persistent back pain, pain radiating down the legs, or difficulty walking or standing for extended periods.
These symptoms may be warning signs of serious conditions such as spondylolisthesis, spinal stenosis, or nerve compression. In patients with a history of spinal surgery, anatomical changes over time can make subsequent treatment much more complex. Early diagnosis and timely intervention at reputable healthcare facilities are key to protecting mobility and quality of life.
For more information about the treatment of spinal conditions at FV Hospital, readers can visit FV Hospital at 6 Nguyen Luong Bang street, Tan My ward (formerly District 7), Ho Chi Minh City, or call (028) 35 11 33 33. FV accepts Vietnam’s public health insurance, private health insurance, and offers instalment payment options for hospital bills.
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