Management of isthmic spondylolisthesis with posterolateral endoscopic foraminal decompression

Abstract

Study design: Prospective evaluation of 24 consecutive patients with isthmic spondylolisthesis with chronic back, buttock, and leg pain treated by endoscopic foraminal decompression and followed for a minimum of 2 years.

Objectives: To assess the efficacy of endoscopic foraminal decompression and mobilization of the exiting and transiting nerves, discectomy, ablation of osteophytes, and impinging pars as a means of treatment by the posterolateral approach.

Summary of background data: Open decompression with or without fusion is a commonly accepted procedure for symptomatic isthmic spondylolytic spondylolisthesis in patients who fail to respond to conservative treatment. There is no published data on the outcome of endoscopic procedures for this condition.

Methods: Endoscopic foraminal decompression achieved with laser-assisted bone and soft-tissue ablation was performed on 12 males and 12 females with an average age of 42.4 years (36-72 years) followed for an average period of 34 months (28-46 months). The average preoperative duration of symptoms was 6.1 years (3-9 years).

Results: One hundred percent cohort integrity was maintained at the final follow-up. Results were analyzed using the percentage change in Oswestry Disability Scores and in Visual Analogue Pain scores. Using a percentage change in Oswestry Disability Score of 50 or more plus VAP scores of 50 or more to determine good and excellent outcomes, 79% (19 out of 24) exceeded this value.

Conclusion: Laser-assisted endoscopic foraminal decompression provides a minimalist means of exploring the extraforaminal zone, the isthmic defect, the foramen and its contents, the disc and the epidural space. It allows adequate resection with decompression and discectomy, without the need for open decompression and fusion, and targets the symptomatic level effectively in patients with Grade I-III isthmic spondylolisthesis.