Single-stage posterior surgical management of grade 5 L5 spondylolisthesis in a patient with neurofibromatosis type 1 and dural meningocele: illustrative case.

To the best of the authors' knowledge, this is the first reported case of Meyerding grade 5 L5 spondylolisthesis complicated by neurofibromatosis type 1 (NF1) and dural meningocele, successfully managed via a single-stage posterior approach-a well-established technique adapted for this complex scenario. Surgical management of grade 5 spondylolisthesis remains challenging. A 18-year-old female was admitted to the hospital for low back pain and radicular pain of both lower limbs. Radiographic imaging showed grade 5 spondylolisthesis of L5. On MRI, dural meningocele could be seen extending through the intervertebral foramina of L4-5, the first anterior and dorsal sacral foramina on the left. After halo traction for 3 months, there was little improvement. The authors decided to perform a single-stage posterior L5 vertebrectomy, sacral dome osteotomy, and L2-S1 pedicle screw fixation. This patient experienced temporary disability in raising her legs but recovered 3 days later. At the 1.5-year follow-up, CT showed good bone fusion. All the pedicle screws were in good position and the cage was not dislocated. Base on the related literature, there are different choices for the treatment of high-grade spondylolisthesis of L5 with NF1 and dural meningocele. In the authors' opinion, single-stage posterior surgery may be a choice that achieves good clinical results. https://thejns.org/doi/10.3171/CASE25191.