Direct Pars Defect Tubular Decompression and TLIF for the Treatment of Low-Grade Adult Isthmic Spondylolisthesis: Surgical Challenges and Nuances of a Muscle-Sparing Minimally Invasive Approach.

Fabio Roberti,Katie Arsenault

doi:10.1155/2020/5346805

Fabio Roberti, Katie Arsenault

Open Access

https://doi.org/10.1155/2020/5346805

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Abstract

We present an illustrative report on the use of a minimally invasive, muscle-sparing, direct pars defect decompression with transforaminal lumbar interbody fusion (TLIF) and instrumentation for the treatment of low-grade adult isthmic spondylolysis with spondylolisthesis and discuss the surgical challenges and nuances associated with the technique.

Highlights

Lumbar spondylolysis, an osseous congenital or acquired defect of the pars interarticularis, is a known cause of progressive low back pain in young patients
Minimally invasive direct surgical treatments for lumbar spondylolysis have been well described [1,2,3] and minimally invasive instrumented fusion techniques are nowadays often selected to treat patients with lumbar spondylolisthesis [4,5,6,7,8,9,10], we believe that the addition in the literature of short illustrative surgical reports addressing the surgical nuances and technical challenges associated with minimally invasive direct pars fracture decompression for isthmic spondylolysis with spondylolisthesis could be of benefit to surgeons in training and surgeons in the early stages of their minimally invasive surgery learning curve. e presence of fibrous pseudohealing near the fracture line may pose a surgical anatomy challenge that is not seen in degenerative spondylolisthesis, especially if combined to the relatively limited exposure allowed by a tubular approach
We present a report with intraoperative images of two cases where such technique was adopted and discuss surgical challenges that may be encountered during this approach

Summary

Introduction

An osseous congenital or acquired defect of the pars interarticularis, is a known cause of progressive low back pain in young patients. In adults or elderly patients with a history of chronic back pain, isthmic spondylolysis is often associated to symptomatic spondylolisthesis at the affected level. Minimally invasive direct surgical treatments for lumbar spondylolysis have been well described [1,2,3] and minimally invasive instrumented fusion techniques are nowadays often selected to treat patients with lumbar spondylolisthesis [4,5,6,7,8,9,10], we believe that the addition in the literature of short illustrative surgical reports addressing the surgical nuances and technical challenges associated with minimally invasive direct pars fracture decompression for isthmic spondylolysis with spondylolisthesis could be of benefit to surgeons in training and surgeons in the early stages of their minimally invasive surgery learning curve. We present a report with intraoperative images of two cases (grade 1 and 2 isthmic spondylolisthesis) where such technique was adopted and discuss surgical challenges that may be encountered during this approach

Operative Technique

Discussion

Conclusion