Spondylolisthesis with sciatica. Magnetic resonance findings and chemonucleolysis

Area of Science:

• Orthopedics
• Neurosurgery
• Radiology

Background:

• Bilateral lumbar isthmic spondylolisthesis often presents with unilateral sciatica.
• Disc protrusion at the spondylolisthesis level is a common finding.
• Nerve root compression can result from central or foraminal disc herniations.

Purpose of the Study:

• To evaluate the efficacy and outcomes of chemonucleolysis in patients with bilateral lumbar isthmic spondylolisthesis and unilateral sciatica.
• To assess the impact of chemonucleolysis on disc protrusion and nerve root compression using magnetic resonance imaging (MRI).

Main Methods:

• Fifteen patients with bilateral lumbar isthmic spondylolisthesis and unilateral sciatica underwent MRI.
• All patients had disc protrusion at the spondylolisthesis level.
• Treatment involved chemonucleolysis, followed by a 19-month average followup.

Main Results:

• Chemonucleolysis was performed without complications in all 15 patients.
• Good or excellent outcomes were reported in 10 of 12 patients with L5 spondylolisthesis and 1 of 3 with L4 spondylolisthesis.
• MRI follow-up showed decreased dural sac deformation in 4 patients and no distinct foraminal changes in most.

Conclusions:

• Chemonucleolysis appears to be a safe and effective treatment for sciatica secondary to disc protrusion in patients with lumbar isthmic spondylolisthesis.
• Outcomes are more favorable for patients with L5 spondylolisthesis compared to L4.
• MRI findings suggest potential for reduced disc herniation and nerve compression post-treatment.