Trans-Spinous Process Vertebropexy Technique for Low-Grade Degenerative Spondylolisthesis: A Case Series

Retrospective study.

To evaluate clinical and radiologic outcomes of fusionless lumbar spine stabilization using a tendon allograft loop through the spinous process, following microsurgical decompression to address procedure-related destabilization.

The limitations of traditional spinal fusion and decompression surgeries have driven the development of motion-preserving alternatives that maintain natural vertebral mobility while providing structural stability, thereby reducing complications and long-term consequences associated with rigid fixation.

Twenty patients with low-grade stable degenerative spondylolisthesis who underwent primary lumbar decompression for spinal stenosis and ligamentous stabilization using the trans-spinous tendon allograft technique between 2022 and 2023 were included. The Oswestry disability index (ODI) and visual analog scale (VAS) for back/leg pain were recorded. Radiographs assessed adjacent segment degeneration and spinous process integrity, and MRI scans evaluated decompression and tendon allograft status.

Median ODI improved significantly at all time points compared with baseline: 6-month ODI: 16 points (IQR=4.5-26), P =0.0013; 1-year ODI: 16.5 points (IQR=4-22), P =0.0013, with no significant difference between 6-month and 1-year results ( P =1). Similar trends were observed for scores. One patient required revision surgery due to a facet joint cyst compressing a nerve root. Eleven patients (55%) experienced spinous process fractures, but clinical outcomes did not differ between patients with and without fractures: 6-month ODI: P =0.921, 1-year ODI: P =0.985; 6-month VAS back: P =0.507, 1-year VAS back: P =0.767; 6-month VAS leg: P =0.826, 1-year VAS leg: P =0.747. Patients with fractures were significantly older ( P =0.023).

The trans-spinous process vertebropexy technique with decompressive bilateral laminotomy compromises spinous process integrity, causing high fracture rates. Although these fractures have minimal clinical impact, the current stabilization technique should be abandoned due to inadequate safety and efficacy. Technique refinement, larger prospective studies, and extended follow-up are necessary before clinical implementation.

Level III-retrospective analysis.