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Published on: August 7, 2018
Interbody Fusion and Percutaneous Reduction For Lumbar Spondylolisthesis With Mobile Microendoscopic Discectomy
Baoshan Xu1, Haiwei Xu, Hao Zhang
1Department of Minimally Invasive Spine Surgery, Tianjin Hospital, Tianjin, People's Republic of China.
Study Design:
A minimally invasive surgical technique for lumbar spondylolisthesis.
Objective:
The objective of this study was to investigate the feasibility and clinical efficacy of interbody fusion and percutaneous reduction for lumbar spondylolisthesis using mobile microendoscopic discectomy (MMED) technique.
Summary Of Background Data:
Current surgical techniques for lumbar spondylolisthesis cause considerable trauma, so a minimally invasive technique is needed.
Materials And Methods:
A total of 62 patients of lumbar spondylolisthesis (40 patients of degenerative spondylolisthesis and 22 patients of isthmic spondylolisthesis) were treated with interbody fusion and percutaneous reduction using the MMED technique. A 2.5-cm longitudinal incision was made on the side of dominant symptoms, with paraspinous approach used for degenerative spondylolisthesis and transforaminal approach for isthmic spondylolisthesis. The fenestration and decompression were performed under MMED. The intervertebral space was released through an outer tube under direct vision, followed by bone graft and cage implantation. Percutaneous pedicle screws were used, with the residual spondylolisthesis further reduced. The patients were followed up to evaluate the clinical results.
Results:
The procedure was successful in all patients. Postoperative radiographs showed sufficient decompression and improvement of spinal alignment for both groups. The average reduction rate of the spondylolisthesis was 68% for degenerative spondylolisthesis group and 66% for isthmic spondylolisthesis group. The patients of 2 groups were followed up for 12-24 months. At the final follow-up, the Oswestry Disability Index and Visual Analogue Scale scores decreased significantly compared with preoperation for both groups. The clinical results were excellent in 22 cases, good in 16 and fair in 2 for degenerative spondylolisthesis group, and excellent in 11 cases, good in 10 and fair in 1 for isthmic spondylolisthesis group according to the Macnab Scale.
Conclusion:
Interbody fusion and percutaneous reduction with MMED provides a minimally invasive procedure for lumbar spondylolisthesis, with sufficient decompression, reduction, fusion, and satisfactory clinical results.
