title: A case report of 3-level degenerative spondylolisthesis with spinal canal stenosis.
abstract: BACKGROUND
  Lumbar degenerative spondylolisthesis is a major cause of impaired quality of life and diminished functional capacity in the elderly. Degenerative spondylolisthesis often involves only one or two level and tend to present with one or two level spinal canal stenosis.
  
  
  METHODS
  The authors describe an unusual case of degenerative spondylolisthesis involving 3 levels of the lumbar spine from L2 to L5. The patient was a 58-year-old woman who suffered chronic back pain and neurogenic claudication. Plain radiography revealed grade I degenerative spondylolisthesis at L2-L3, L3-L4 and L4-L5. Elevated pedicle-facet joint angles and W-type facet joints at the lumbar spine was observed. Magnetic resonance imaging showed L2-S1 spinal cord compression at the lumbar spine. Patient underwent L2-S1 decompression laminectomy and posterior lateral fusion of L2-S1 with posterior instrumentation and bone grafting. Symptoms improved significantly at 4 months follow-up.
  
  
  CONCLUSIONS
  Thorough evaluation for multilevel segmental involvement in degenerative spondylolisthesis is important because of the frequency of severe symptomatic spinal stenosis or foraminal encroachment. Good surgical outcome can be expected from decompression and stabilisation. The pathogenesis of multi-level lumbar degenerative spondylolisthesis can be complex and heterogeneous.
authors: Department of Orthopaedics Surgery, Changi General Hospital, Singapore. Electronic address: zell53@hotmail.com.
authors: Ing How
authors: IH
authors: Moo
authors: University Malaya Medical Centre, Malaysia. Electronic address: vivien.tsw@hotmail.com.
authors: See Wei
authors: SW
authors: Tan
authors: Department of Orthopaedics Surgery, Changi General Hospital, Singapore. Electronic address: nirajkasat@yahoo.com.
authors: Niraj
authors: N
authors: Kasat
authors: Department of Orthopaedics Surgery, Changi General Hospital, Singapore. Electronic address: paulthng@cgh.com.
authors: Leong Keng
authors: LK
authors: Thng
keywords: Multi-level; Spinal stenosis; Spondylolisthesis