World neurosurgery 2017 01 18() pii S1878-8750(17)30053-0
Currently, the standard surgical treatment for adult isthmic spondylolisthesis consists of various techniques of arthrodesis supplemented with instrumentation. The superiority of this strategy, however, has not been irrefutably proven. Considering the risk associated with the instrumentation surgery, we may justifiably examine a less invasive approach.
We describe a series of nine patients with adult isthmic spondylolisthesis, in whom we microsurgically decompressed the responsible nerve root in the intervertebral foramen through the posterolateral inter-muscular approach. Technical details specific to isthmic spondylolisthesis was reviewed. The two-year outcome was assessed with SF-36 and VAS scores.
The mean age of the patients was 68 ± 7 (SD) years. The mean slip rate of spondylolisthesis measured on the preoperative lumbar X-ray was 20 ± 12 (SD) %. All the patients successfully underwent the procedure without complications. All the examined scores remained significantly better than the preoperative values two years after surgery; the mean VAS score decreased from 7.8 ± 2.8 (SD) preoperatively to 2.8 ± 1.4 (SD) at two years (p = 0.008), average physical score of SF-36 improved from 33.1 ± 9.7 to 52.5 ± 9.4 (p = 0.001), and the bodily pain score improved from 28.0 ± 13.5 to 55.1 ± 9.7 (p = 0.001) CONCLUSIONS: The microsurgical decompression through the posterolateral inter-muscular approach was effective in producing good two-year outcome in patients with adult isthmic spondylolisthesis. This procedure may be considered as a less-invasive alternative in the surgical treatment of adult isthmic spondylolisthesis.