Trans-foraminal endoscopic uniportal decompression in degenerative lumbar spondylolisthesis: a technical and case report

Abstract

Background: Degenerative spondylolisthesis is a common spinal pathology. Traditionally, spinal fusion is an accepted standard surgical treatment for listhesis. But fusion is a major intervention with its known pitfalls. With technological progression, minimally invasive spinal fusion (MISF) procedures are becoming mainstream. Percutaneous trans-foraminal endoscopic lumbar discectomy/decompressions (PTELD) without stabilization has many advantages over even a MISF for select group of patients. Case presentation: In this case report, we describe using a uniportal unilateral trans-foraminal approach (TFA) for stable listhesis with lumbar disc herniation (LDH) causing chronic bilateral radicular symptoms and back pain with acute exacerbation. Under local anesthesia, we used a flat entry for PTELD, which facilitates an approach to both disc sides ventrally and even dorsal aspect lateral recess decompression on the dominant ipsilateral side. No fixation was done. An excellent outcome is obtained immediately at 6 weeks and maintained at 39 months of follow-up. Conclusion: PTELD is worth considering as an intermediate procedure before fusion is offered in lateral recess stenosis in stable listhesis patients who have consented and understand the progressive cascade of spinal degeneration.

Percutaneous transforaminal endoscopic decompression with removal of the posterosuperior region underneath the slipping vertebral body for lumbar spinal stenosis with degenerative lumbar spondylolisthesis: a retrospective study

“…In this study, the patients exhibited no significant progression of slippage during the last follow-up compared to that present preoperatively, indicating that PTED will not affect the natural process of LSS with DLS, which corroborates previous reports [ 14 , 16 , 20 ]. Ahuja et al [ 27 ] found that the removal of more than 30% of the facet joint would increase spinal mobility and the pressure in the intervertebral disc.…”

“…It is widely recognized that patients with unstable DLS, especially those with obvious axial pain, will benefit from fusion [ 19 ]. Several studies have shown that there are two criteria for selecting decompression alone in a population of patients with DLS and LSS: (1) mainly characterized by symptoms of radicular pain and neurogenic claudication [ 20 ]; (2) stable DLS (sagittal translation ≤ 3 mm on standing extension-flexion radiographs radiograph or angular displacement ≤ 10°) [ 12 , 13 ]. Therefore, for patients with stable DLS and LSS with neurological symptom, the main purpose of surgery is to relieve nerve compression, and vertebral fusion and fixation are not necessary.…”

End-points of Decompression of in Lumbar Transforaminal Endoscopic Spine Surgery: A Narrative Review of Objective and Subjective Criteria to Prevent Failures

“…For the LRS, the caudal foramen is focussed, and additional adjoining pedicle removal is needed many times in addition to sculpting of SAP, inferior articular process, LF and capsule. Visualisation of the entire pulsatile TNR on ventral, lateral and dorsal aspect confirms the EPD (Supplementary Video 9) [43]. For central LSS, or unilateral ventral stenosis, ventral decompression by removal of the LDH, buckling annulus (which is usually hardened or calcified) and removal of the superior vertebral end plate spur of the inferior vertebra is done (Supplementary Video 10).…”

Expanded Indications of Full Endoscopic Spine Sugery

“…An endoscopic visualised burred foraminoplasty (BF) or OI approach is taken when there is a technical requirement to reach more dorsal in epidural space 59,61,65,66) . A recent mobile OI technique described does not focus on any enlargement of foramen but on the precise placement of the cannula within the foramen 67,68) .…”

“…Reaching to the central dorsal aspect is difficult by transforaminal approach. Though indirect decompression by removing the ventral upper endplate spur of lower vertebra can enlarge the central canal also 65,111) (Figure 6).…”