Percutaneous Transforaminal Endoscopic Surgery (PTES) and OLIF with Self-lock Cage through mini-incision for Surgical Treatment of L5 Spondylolisthesis

Abstract

Purpose: We designed Percutaneous Transforaminal Endoscopic Surgery (PTES) technique and OLIF with self-lock cage through mini-incision for the treatment of L5 spondylolisthesis. The purpose of study is to evaluate the feasibility, efficacy and safety of this method.Methods: Thirteen cases of L5 spondylolisthesis with nerve root symptoms were included in this study. PTES under local anesthesia, and then OLIF with self-lock cage and allograft under general anesthesia was performed. Back and leg pain were preoperatively and postoperatively evaluated using VAS, and the clinical outcomes were evaluated with ODI before surgery and at 2-year follow-up. Anterior and posterior intervertebral space height, lumbar lordotic angle, and operative segmental lordotic angle were measured on lumbar spine X-rays preoperatively and postoperatively. The fusion status was assessed according to the Bridwell’s fusion grades.Results: The VAS significantly dropped after surgery and the ODI decreased from 64.7±7.8% to 12.9±4.3% 2 years after surgery (p<0.001). Anterior and posterior intervertebral space height, and operative segmental lordotic angle significantly improved after surgery (p<0.05). Fusion grades based on the Bridwell grading system at 2-year follow-up were grade I in 9 segments (69.2%), grade II in 4 segments (30.8%). No patients had any form of permanent iatrogenic nerve damage and a major complication. No failure of instruments was observed.Conclusion: PTES and OLIF with self-lock cage is a good choice of minimally invasive surgery for L5 spondylolisthesis, which can get direct neurologic decompression and satisfying fusion, and hardly destroy the rectus abdominis and its sheath, paraspinal muscles and bone structures.