Management of spondylolisthesis using MIS techniques: Recent advances

Abstract

The authors discuss the recent advances in the understanding and management of spondylolisthesis. The two most common kinds of spondylolisthesis - Degenerative and Spondylolytic types have been elaborated in this paper, with the understanding that similar management principles can be applied to the other lesser common varieties. The impetus has been on application of minimally invasive techniques in the treatment as well as renewed interest in stand-alone decompression in degenerative spondylolisthesis.

Keywords: Degenerative spondylolisthesis; Endoscopic spine surgery; Lumbar canal stenosis; Minimally invasive spine surgery; Robotics; Spinal stenosis; Spondylolisthesis; Spondyloptosis.

Fig 1

A schematic diagram showing over the top contralateral tubular decompression.

Fig 2

A schematic diagram showing ipsilateral tubular decompression.

Fig 3

Pre -operative radiograph of a patient with degenerative spondylolisthesis.

Fig 4

Post -operative radiograph after MISTLIF in the same patient.

Fig 5

Pre-operative MRI and dynamic radiographs of Case-1.

Fig 6

Three months follow up MRI and dynamic radiographs of Case 1.

Fig 7

Four years follow up dynamic radiographs of Case 1.

Fig 8

Pre-operative dynamic radiographs & MRI and Post-operative radiograph of Case 2.

Fig 9

High grade listhesis pre-operative, intraoperative and post -operative images.

Fig 10

Pre-operative, intraoperative reduction and postoperative images of low grade listhesis.

Fig 11

Lines (yellow) indicating pedicle screw trajectory for L5 and S1 screws and the respective length of surgical exposure required in a patient with conventional open technique.

Fig 12

Pre-operative images of spondyloptosis and good postoperative reduction using MIS TLIF.

Fig 13

Tubular retractor fixed in the trajectory of the L5-S1 disc serves as a continuous guide to introduce various instruments.

Fig 14

Follow up x-ray showing good reduction of listhetic segment.