Microdecompression without fusion for radiculopathy associated with lytic spondylolisthesis

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Spinal Surgery

Background:

• Standard treatment for L-5 nerve root compression with spondylolisthesis involves extensive surgery (bilateral decompression, fusion, instrumentation).
• This approach carries significant surgical morbidity and risks of iatrogenic instability.
• A less invasive option focusing on nerve root decompression without fusion is explored.

Purpose of the Study:

• To evaluate the efficacy and safety of unilateral microdecompression for L-5 nerve root compression.
• To assess outcomes in patients with mild spondylolisthesis and predominantly radicular pain.

Main Methods:

• Nine patients with unilateral L-5 radicular symptoms, minimal back pain, and mild spondylolisthesis underwent unilateral microdecompression.
• No fusion or instrumentation was performed.
• Patients were followed for short- and long-term outcomes.

Main Results:

• All nine patients experienced significant relief of radicular pain.
• One patient developed increased back pain, leading to a recommendation for cases with <= 25% spondylolisthesis.
• The procedure demonstrated effectiveness and safety in this cohort.

Conclusions:

• Unilateral microdecompression without fusion is a safe and effective treatment for radicular pain in carefully selected patients.
• This technique offers a viable alternative to more extensive decompression and fusion surgeries.
• Consideration for this approach is recommended for patients with lytic pars defects, mild spondylolisthesis, and minimal back pain.