[Treatment of spondylolisthesis (stage I-II) by neurosurgical decompression without either osteosynthesis or...

Between 1978 and 1982, 45 patients (44 adults, 1 child) with lumbar isthmic spondylolisthesis (SPL) were operated upon, through a classical posterior approach without setting or fixing. 46 SPL were at the L5-S1 level, 9 at the L4-L5, with 31 class I and 14 class II SPL, according to Meyerding. All the patients had experienced backache with radicular pain. A bilateral interlaminar way with preserving the posterior arch, allowed a large dural and radicular decompression. At the slipping level the wedge-shaped bone was removed while stripping off the disc together with its cartilaginous layer. Every possibility of root compression was cleared up: fibrosis, soft discs, osteophytic spurs, roof of the intervertebral foramina, with exploration of the adjacent levels. Neither bone graft or metallic devices were used. Apophyseal joints and their synovial membrane were denervated by coagulation. The postoperative course was uneventful. Bracing was needed for 2 months. X-ray postoperative follow-up demonstrated an important narrowing of the intervertebral space with constitution of a solid intersomatic fibrous joint without increase of slipping. Good and excellent results were obtained in 68% of cases, fair result in 20% with A 1 to 4 years follow-up. 80% of patients returned to their pre-operative occupation. After reviewing the data of the literature the authors ascertain that more complicated and sophisticated procedures do not bring out better results. They conclude that their safe and simple technique should be widely advocated for lumbar class I and II spondylolisthesis.