Lateral Approach for Spondylolisthesis

Abstract

Spondylolisthesis causing central spinal canal or neuroforaminal stenosis is one of the most common indications for lumbar decompression and fusion. Patients typically present with back and leg pain. The back pain is typically mechanical, particularly if the listhesis is mobile; the leg pain is typically radicular. Neurogenic claudication is often described in patients with central canal stenosis. Several studies have documented superior outcomes in surgical cohorts of patients with symptomatic spondylolisthesis as compared to their counterparts managed conservatively. Direct lateral, or extreme lateral, interbody fusion is a safe, minimally invasive alternative to traditional open decompression and fusion procedures to treat spondylolisthesis. Lateral interbody fusion reduces the listhesis, restores disk height, indirectly decompresses the nerve roots, and inhibits motion across an unstable segment. The nerves of the lumbosacral plexus pass through the psoas muscle fibers, and they are at risk of injury when accessing the spine using a transpsoas approach. Thigh symptoms such as numbness, pain, and weakness have been noted to be relatively common postoperatively, but these symptoms are largely transient.