Transforaminal endoscopic discectomy to relieve sciatica and delay fusion in a 31-year-old man with pars defects and low-grade spondylolisthesis

Abstract

<jats:p>Isthmic spondylolisthesis due to pars defects resulting from trauma or spondylolysis is not uncommon. Symptomatic patients with such pars defects are traditionally treated with a variety of fusion surgeries. The authors present a unique case in which such a patient was successfully treated with endoscopic discectomy without iatrogenic destabilization.</jats:p> <jats:p>A 31-year-old man presented with a history of left radicular leg pain along the distribution of the sciatic nerve. He had a disc herniation at L5/S1 and bilateral pars defects with a Grade I spondylolisthesis. Dynamic radiographic studies did not show significant movement of L-5 over S-1. The patient did not desire to have a fusion. After induction of local anesthesia, the patient underwent an awake transforaminal endoscopic discectomy via the extraforaminal approach, with decompression of the L-5 and S-1 nerve roots. His preoperative pain resolved immediately, and he was discharged home the same day. His preoperative Oswestry Disability Index score was 74, and postoperatively it was noted to be 8. At 2-year follow-up he continued to be symptom free, and no radiographic progression of the listhesis was noted.</jats:p> <jats:p>In this case preservation of stabilizing structures, including the supraspinous and interspinous ligaments and the facet capsule, may have reduced the likelihood of iatrogenic instability while at the same time achieving symptom control. This may be a reasonable option for select patient symptoms confined to lumbosacral radiculopathy.</jats:p>

Minimally-Invasive versus Conventional Repair of Spondylolysis in Athletes: A Review of Outcomes and Return to Play

“…Transforaminal endoscopic microdiscectomy was performed in a 31-year-old patient with foraminal stenosis and symptomatic pain radiating to his legs. This patient had minimal spondylolisthesis and stable flexion/extension X-ray images [ 31 ]. Postoperatively, the patient experienced a complete resolution of his symptomatic pain.…”

Management of Lumbar Radiculopathy Associated With an Extruded L4-L5 Spondylolytic Spondylolisthesis Using Flexion-Distraction Manipulation: A Case Study

“…18 SS in young adults and in athletes responds favorably to nonsurgical care, with a significant reduction in pain and good long-term outcomes in nearly 80% of cases. 19 Longo et al report that most patients with spondylolistheses experience satisfactory results with nonsurgical care, and surgery should be considered only in patients with "highgrade slippage" (greater than 50%) with persistent neurologic symptoms or pain in the lower back or leg, those with persistent signs of neurogenic claudication, and those who have failed to improve with a minimum of 3 months of conservative, nonsurgical care. 20 Successful conservative care options for the treatment of SS include modification of activities, therapeutic exercises, and traction, in addition to spinal manipulative therapy and flexion-distraction manipulation applied above and below the involved spinal level.…”

Transforaminal Endoscopic Decompression of the Lumbar Spine for Stable Degenerative Spondylolisthesis as the Least Invasive Surgical Treatment Using the YESS Surgery Technique

“…Yeung reviewed 58 patients with degenerative and isthmic spondylolisthesis from 2003 to 2013 from his personal database. Neither statistical analysis was performed nor powered for this study but results from the review were used to create a stratification strategy going forward [10]. Encouraged by the feedback from Yeung's returning patients and an electronic survey with Survey Monkey software, and with loyal patients who maintained contact or who updated their clinical status, most only had recurrent minor symptoms that was not severe enough to require further surgical intervention, but only needed follow-up reassurance or advice.…”