Abstract
BackgroundDegenerative 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 presentationIn 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.ConclusionPTELD 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.
Highlights
ConclusionPercutaneous trans-foraminal endoscopic lumbar discectomy/decompressions (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
Degenerative spondylolisthesis is a common spinal pathology
Spine surgery has seen a significant progress from conventional open surgery to minimally invasive spinal fusion (MISF)
Summary
PTELD is an effective technique to do ventral decompression with the disc as the main component of stenosis in a case of stable listhesis with predominant unilateral symptoms. The unilateral approach cannot decompress the opposite side dorsal stenosis. It is not a permanent replacement for fusion. PTELD should only be considered as an intermediate procedure for selected demanding patients
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