Transforaminal endoscopic discectomy with foraminoplasty for the treatment of spondylolisthesis

Background: lumbar degenerative spondylolisthesis is a common entity and occurs mainly in elderly patients. the trend in surgery has been to offer decompression with instrumented fusion based on patient-based outcome data and the inherent instability of the condition.objectives: transforaminal endoscopic discectomy and foraminotomy is an ultra-minimally invasive outpatient surgical option available to patients that does not require general anesthesia and does not involve the same amount of destabilizing facet joint removal as a traditional laminectomy and medial facetectomy. the purpose of this study was to assess the benefit of tranforaminal endoscopic discectomy and foraminotomy in patients with lumbar 4-5 (l4-l5) and lumbar 5-sacral 1 (l5-s1) spondylolisthesis and lumbar radiculopathy.methods: after institutional review board approval,charts from 21 consecutive patients with l4-l5 or l5-s1 spondylolisthesis and complaints of lower back and radicular pain who underwent endoscopic procedures between 2007 and 2012 were reviewed.results: the average pain relief one year postoperatively was reported to be 71.9%,good results as defined by macnab. the average pre-operative vas score was 8.48,indicated in our questionnaire as severe and constant pain. the average one year postoperative vas score was 2.30,indicated in our questionnaire as mild and intermittent pain.limitations: this is a retrospective study and only offers one year follow-up data for patients with spondylolisthesis undergoing endoscopic spine surgery for treatment of lumbar radiculopathy.conclusions: endoscopic discectomy is a safe and effective alternative to open back surgery. the one year follow-up data presented here appears to indicate that an ultra-minimally invasive approach to the treatment of lumbar radiculopathy in the setting of spondylolisthesis that has a low complication rate,avoids general anesthesia,and is outpatient might be worth studying in a prospective,longer term way. © 2014,american society of interventional pain physicians. all rights reserved.