Transforaminal Endoscopic Lumbar Decompression for Isthmic Spondylolisthesis: Technique Description and Clinical Outcome.

OBJECTIVES: To describe a transforaminal endoscopic spinal decompression technique for treating adult patients with isthmic spondylolisthesis and report preliminary surgical and radiological results.

BACKGROUND: Spondylolisthesis is prevalent in the general population. Surgical approaches for symptomatic spondylolisthesis that is refractory to conservative treatment vary. Direct repair of pars fractures and spinal nerve decompression with or without fusion have been reported with varied clinical results. The de facto gold standard, "fusion," is often associated with high complication rates and costs, and may not be necessary for many patients whose spine is relatively stable.

METHODS: Transforaminal endoscopic lumbar decompression (TFELD) was performed to resect fractured bone or bone fragments and inflamed tissue compressing the exiting nerve root in 2 patients with isthmic spondylolisthesis (grade 1 in one patient and grade 2 in another). We describe the technique step*by-step and assess the Oswestry Disability Index and pain scores for back and leg pain before and after surgery.

RESULTS: Radiographic images demonstrated spondylolisthesis with L5 pars fracture. The fractured bone and bone fragment were intraoperatively visible in the gap between facets and fractured pars in patients with isthmic spondylolisthesis. The core pathology of the patients was fractured bone and bone fragment coupled with scar or inflamed tissue compressing the exiting L5 nerve roots. After the bone fragments and scar tissue were removed using TFELD, the patients' back and leg pain was significantly reduced, and physical function was restored.

CONCLUSION: For patients with spondylolisthesis-associated low back and leg pain without spinal instability, TFELD is a safe and effective surgical treatment option.