Full-endoscopic Foraminotomy in Degenerative Spondylolisthesis: A “Module-based” Approach for Surgical Planning and Execution

Abstract

Purpose Degenerative Lumbar Spondylolisthesis (DSL) is a common spinal pathology characterized by the anterior slippage of one vertebral body on another. DSL is caused mainly by degeneration of the intervertebral disc in the first place, with subsequent degeneration of the facet joints that end causing the slippage. As the disease evolves, stability is restored as a result of advanced degeneration and disc collapse. But while this natural evolution takes place, DSL may produce radicular symptoms by different mechanisms. To present a “module-based” approach for the surgical planning and execution of full-endoscopic foraminotomy in DSL, combined with case examples of the most common surgical scenarios. Methods We propose a “module-based surgery” using the standard endoscopic foraminotomy technique as a baseline. According to the patient’s clinical and imaging characteristics, several “modules” can be added. The resulting endoscopic surgery is a summation of the basic endoscopic foraminotomy plus all the additional required modules. ResultsSurgical modules description and case examples are provided. ConclusionTransforaminal lumbar endoscopic foraminotomy represents a minimally invasive technique to treat foraminal and combined foraminal-lateral recess stenosis. DSL and its multiple scenarios represent a challenge to the endoscopic surgeon. Module-based approach can help systematize and execute these demanding endoscopic procedures.

Outcomes of Microscopic-Assisted Decompression Surgery Without Instrumented Fixation in Patients With Spinal Canal Stenosis and First-Degree Degenerative Spondylolisthesis: A Prospective Case Series

“…Surgical interventions can be broadly classified into decompression alone or decompression with fusion (posterolateral fusion/interbody fusion) when obvious dynamic instability is present [12,13]. Although the conventional open techniques of decompression (which involve laminectomy) remain the gold standard of treatment [12,14], problems with paraspinal musculature denervation [15] and possibility of secondary lumbar instability [16] and creation of dead space [17] resulted in increased interest in less invasive techniques [18][19][20][21][22], with reported noninferior clinical outcomes [21,22]. Among them, the minimally invasive surgical (MIS) decompression via a unilateral laminotomy with bilateral decompression-the 'over-the-top' approach, is thought to be less destabilizing than all other techniques [23][24][25][26].…”

“…While several innovations and techniques exist to perform less invasive decompressions, including subarticular fenestration and multiple laminotomies [19][20][21], microscopic decompression [25,31] and tubular decompression [32][33][34][35], the aim of this study is to report our outcomes of microscopic-assisted decompression in first-degree symptomatic DS cases through over-the-top technique, particularly regarding clinical improvement and radiological progression of instability. Despite the presence of similar published reports regarding the same tech-nique [24][25][26], the existing prospective studies were few and the results were nonconsistent specially regarding slip progression.…”