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            [0] => Unexpected change of surgical plan in high grade lumbar dysplastic spondylolisthesis
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            [0] => HMPIT
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    [nom] => Array
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            [0] => Ghrissi
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    [prenom] => Array
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            [0] => Sirine
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    [email] => Array
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            [0] => ghrissisirine3@gmail.com
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Nom prénom / Name Surname: Borcheni Nizar
Email: nizarborchani@gmail.com
Hôpital / Hospital: HMPIT

 
Nom prénom / Name Surname: Manai Mohamed
Email: Mohamedmanai@gmail.com
Hôpital / Hospital: HMPIT

 
Nom prénom / Name Surname: Znagui Talel
Email: z_talel@yahoo.fr
Hôpital / Hospital: HMPIT

 
Nom prénom / Name Surname: Abdennadher Achraf
Email: dr.achrafabn@gmail.com
Hôpital / Hospital: HMPIT

 
Nom prénom / Name Surname: Amri Khalil
Email: akhalilkh@gmail.com
Hôpital / Hospital: HMPIT

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    [specialite] => Array
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            [0] => Chirurgie orthopédique et traumatologique
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    [pays] => Array
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            [0] => Tunisie
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            [0] => Introduction : high-grade dysplastic spondylolisthesis with undiagnosed spina bifida occulta can lead to severe low back pain in young adult and may cause cauda equina syndrom. The treatment can be challenging and requires preoperative planning.
Materiel : We reported the case of a 25-year-old woman followed in our department for a symptomatic high-grade dysplastic spondylolisthesis.
Case presentation : A 25-year-old woman presented with bilateral L5 lumbosciatica resistant to medical treatment, with significant impairment of quality of life. Her Oswestry Low Back Pain Disability was at a complete desability and she had a severe Impaired walking ability. Her physical axamination showed a spinal and bilateral radicular syndrome with an unremarkable neurological exam.
Additional tests showed L5-S1 displastic spondyloptosis with a presence of spina bifida occulta confirmed on CT. The sagittal balance was Roussouly type 4. MR revealed a central and bilateral L5 compression on a normal-sized lumbar canal.. Preoperative planning included L4-S1 decompression and arthrodesis with L5-S1 posterior transdiscal fixation. We observed intraoperatively, after positioning, a spontaneous reduction of the spondylolisthesis to grade 2. A significant bony defect in the posterior aspect of S1 was noted. Then, A L5-S1  fixation with distraction and posterior fusion using a massive graft from the posterior iliac crest were performed. 
At last follow-up, the patient presented with a resolution of sciatica and significant improvement in low back pain. The Oswestry Low Back Pain Disability was at mild disability with a good fusion rate.
Discussion : high grade lumbar dysplastic spondylolisthesis is hard to manage despite accurate preoperative planning and only case reports have been noted in the literature. In our case intraoperative reduction with careful fixation was performed. The Instable lumbo-sacral spondylolisthesis seemed to be the cause of the spinal and nerve compression and no decompression was needed, That could achieve a good clinical and functional outcome.
Conclusion : The management of high grade lumbar dysplastic spondylolisthesis is tricky and challenging. It requires expert hands in spine surgery to be able to adapt to unforeseen intraoperative circumstances, and avoid iatrogenic damage to neural elements.
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