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. 2024 May 28:17:1953-1965.
doi: 10.2147/JPR.S454771. eCollection 2024.

Percutaneous Transforaminal Endoscopic Lumbar Foraminotomy in Stable Degenerative Lumbar Isthmic Spondylolisthesis with Radicular Leg Pain: A Retrospective Study

Rongbo Yu  1 , Yiliu Xiang  1 , Haoduan Dou  1 , Hewen Li  1 , Yuyang Zheng  1 , Bin Chen  1
Affiliations

Percutaneous Transforaminal Endoscopic Lumbar Foraminotomy in Stable Degenerative Lumbar Isthmic Spondylolisthesis with Radicular Leg Pain: A Retrospective Study

Rongbo Yu et al. J Pain Res. .

Abstract

Objective: Endoscopic surgery is a minimally invasive option for effectively addressing lumbar degenerative diseases. This study aimed to describe the specific technology of percutaneous transforaminal endoscopic lumbar foraminotomy (PTELF) as a therapeutic intervention for managing radicular leg pain (RLP) resulting from stable degenerative lumbar isthmic spondylolisthesis (DLIS) and to present the associated clinical results.

Methods: From March 2022 and April 2023, 25 patients were diagnosed with single-level stable DLIS with RLP and underwent PTELF. Clinical assessments utilized the visual analog scale (VAS), Oswestry Disability Index (ODI), and modified MacNab criteria. All endoscopic surgery videos were reviewed to interpret the pathology associated with DLIS.

Results: The mean age of the cohort was 65.3 ± 11.0 years. The mean preoperative ODI score, VAS score for low back, and VAS score of the leg were 64.1 ± 8.2, 7.0 ± 0.7, and 7.3 ± 0.8, respectively. These scores significantly improved to 16.3 ± 10.4, 2.0 ± 0.6, and 1.7 ± 1.0 at the final follow-up, respectively (P<0.01). The modified MacNab criteria indicated "good" or "excellent" outcomes in 92.0% of cases. Analysis of 23 surgical videos revealed 15 patients with disc herniation, nine with lower vertebral endplate involvement, consistent presence of uneven bone spurs (at the proximal lamina stump and around the foramen), and accumulated scars. Two patients experienced postoperative dysesthesia, and one encountered a recurrence of RLP.

Conclusion: PTELF emerges as a potentially safe and effective procedure for alleviating RLP in patients with stable DLIS. However, additional evidence and extended follow-up periods are imperative to evaluate the feasibility and potential risks associated with PTELF.

Keywords: foraminotomy; local anesthesia; lumbar isthmic spondylolisthesis; radicular leg pain; transforaminal.

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Conflict of interest statement

The authors declare no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Intraoperative perspective images illustrating the establishment of working channels. Sagittal (A) and anteroposterior (B) fluoroscopic images of the TOM Shidi needle. Employing a 6mm bone drill (C) and 8mm bone drill (D) to remove soft and bony tissues. Anteroposterior (E) and sagittal (F) fluoroscopic images of the working cannula.
Figure 2
Figure 2
Intraoperative endoscopic views. (A) Identification of the S1 TNR. (B–D) Identification of the L5 ENR, showcasing pathology of L5 ENR compression, including bone spurs extending from the proximal lamina stump, bone spurs at the edge of the foramen, LF, and DH. (E) Execution of endoscopic lumbar foraminotomy using an endoscopic bone knife to eliminate pathological bone factors around the ENR. Complete decompression of the TNR (F) and ENR (G and H) and the dural exposure from the starting point to ENR.
Figure 3
Figure 3
Preoperative and postoperative CT (computed tomography). (A–D) Preoperative CT highlighting the left L5 pars defect (red arrow) and the unique pathology of foramen stenosis caused by lumbar isthmic spondylolisthesis (white arrow), including bone spurs extending from the proximal lamina stump to the extraforaminal exit zone and bone spurs distributed at the edge of the foramen, lower vertebral endplate. (E–H) Postoperative CT demonstrating the removal of the pathological factor compressing the L5 exiting nerve root (red arrow) and enlargement of the foramen (white arrow).
Figure 4
Figure 4
Preoperative and postoperative MRI (magnetic resonance imaging) scans. (A–C) Preoperative MRI indicating the left L5 pars defect (red arrow) and L5-S1 foramen stenosis (red circle). (D–F) Postoperative MRI revealing foramen enlargement (red arrow) and liberation of the left L5 exiting nerve root (red circle).
Figure 5
Figure 5
Preoperative Lateral X-ray of the standing lumbar spine illustrating the degenerative lumbar isthmic spondylolisthesis with Meyerding Grade II, along with the measurement of slippage percentage.
Figure 6
Figure 6
Postoperative flexion (A) and extension (B) lateral view showing degenerative lumbar isthmic spondylolisthesis and stability of L5-S1 (< 3 mm dynamic sagittal translation).
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