Imaging Findings

Based on the provided X-ray (anteroposterior and lateral) and CT scan images, it is observed that the patient has undergone L4-L5 pedicle screw fixation:

• On the anteroposterior and lateral X-ray images, the implanted pedicle screws and connecting rods appear generally normal in position, with no obvious signs of breakage, loosening, or bending.
• CT cross-sectional images show that the L4-L5 pedicle screws align with the pedicle anatomy without evident bone destruction or significant soft tissue swelling.
• No obvious screw penetration beyond the pedicle cortex or notable involvement of the spinal canal and nerve roots is noted.
• Although metal artifact (high density) partially obscures local soft tissue details, no significant signs of system breakage or loosening are currently observed.

Potential Diagnoses

Taking into account the patient’s history of L4-L5 lumbar spondylolisthesis treated with pedicle screw fixation, the current follow-up imaging primarily needs to consider the following aspects:

• Stability of the internal fixation system: The most common postoperative issues with pedicle screw fixation include screw loosening, breakage, rod bending, or migration. Imaging must be evaluated for any such abnormalities.
• Postoperative fusion status or pseudoarthrosis formation: Assess whether the fusion segments show satisfactory bone healing. Poor fusion may lead to persistent back pain or instability.
• Infection or inflammation: Although deep postoperative infections are relatively rare, CT may reveal local bone destruction, soft tissue swelling, or fluid collections.
• Involvement of nerve roots or spinal canal: Malpositioned screws or scarring/hematoma within the spinal canal may cause neurological symptoms.

Final Diagnosis

Based on the current imaging data, there is a preliminary assessment that the internal fixation system shows no obvious loosening, breakage, or significant displacement, indicating an overall stable postoperative state. No signs suggesting new fractures, clear infection, or significant nerve compression are present.

If the patient’s clinical symptoms (such as persistent low back pain or radicular pain) worsen or if new neurological signs appear, further clinical correlation and examinations (e.g., MRI, blood tests) may be needed to rule out subclinical infection, postoperative scarring, or mild screw loosening.

Treatment Plan and Rehabilitation

If clinical symptoms are mild and not noticeably worsening, the following strategies may be considered:

• Conservative treatment: This includes appropriate pain management (e.g., NSAIDs) and physical therapy measures (heat therapy, physical therapy, massage) to help alleviate postoperative or chronic mild low back pain.
• Rehabilitation exercises: Under the guidance of a surgeon or rehabilitation specialist, gradually begin core strengthening exercises. The goal is to enhance lumbar and back muscle stability and reduce spinal load.
  • Frequency: 3–5 times per week.
  • Intensity: Light to moderate intensity, avoiding sudden or high-load movements.
  • Time: Each session lasts about 20–30 minutes, gradually extended based on tolerance.
  • Type: Includes core stabilization (e.g., plank, supine bridge), lower limb strength training (e.g., straight leg raises), and relaxation-focused stretching.
  • Progression: As symptoms improve and muscle strength increases, gradually enhance training intensity and exercise difficulty, for example by extending plank duration or introducing light resistance.
• Surgical or other interventional indications: If later examinations show screw loosening, hardware breakage, or severe nerve involvement, further surgical evaluation or other interventional treatments may be considered.
• Individualized precautions: Patients with osteoporosis, advanced age, or other comorbidities should comply with the use of spinal support devices (e.g., lumbar braces) and be cautious about high-intensity training risks, while closely monitoring cardiovascular function and fracture risk.

Disclaimer: The above content is provided as a reference based on current imaging and history. It does not replace a professional physician’s in-person diagnosis and treatment. If you have any questions or if your condition changes, please seek medical attention and undergo further assessments promptly.