Microdecompression without fusion for radiculopathy associated with lytic spondylolisthesis

Patients with symptomatic L-5 nerve root compression and associated lytic spondylolisthesis are commonly treated by bilateral wide posterior decompression and concomitant fusion, often accompanied by transpedicular instrumentation. More limited surgery aimed solely at the relief of nerve root compression offers the potential for significant relief of radicular pain while avoiding iatrogenic instability, thereby alleviating the need for arthrodesis with its increased surgical morbidity. Nine patients with unilateral radicular symptoms referable to the L-5 nerve root, minimal back pain, and a lytic pars lesion with mild spondylolisthesis underwent unilateral microdecompression on their symptomatic side without associated fusion. All patients obtained relief of radicular pain at both short- and long-term follow-up examination. One patient demonstrated increased back pain and, accordingly, the procedure is now recommended only for patients with no greater than a 25% spondylolisthesis. Unilateral microdecompression without stabilization is an effective and safe method for relieving radicular pain in patients with a lytic pars defect, a mild spondylolisthesis, and minimal back pain. This therapeutic option should be considered in select cases as an alternative to bilateral wide decompression with fusion and instrumentation.