Microsurgical Posterolateral Foraminotomy on Patients with Adult Isthmic Spondylolisthesis

Transforaminal Endoscopic Lumbar Foraminotomy for the Treatment of L5-S1 Isthmic Lumbar Spondylolisthesis with Foraminal Stenosis: A 1-Year Follow-Up

BACKGROUND

Isthmic lumbar spondylolisthesis (ILS) is a prevalent spinal pathology. Radicular pain in patients is often attributed to L5-S1 ILS combined with foraminal stenosis (FS), making such patients prime candidates for surgical intervention. We herein aimed to elucidate the surgical technique and clinical outcomes of transforaminal endoscopic lumbar foraminotomy (TELF) in the treatment of L5-S1 ILS with FS.

METHODS

From September 2021 to December 2022, 20 consecutive patients were diagnosed with L5-S1 ILS with FS and underwent TELF. All patients were followed up for at least 12 months. The clinical outcomes were evaluated using the visual analog scale (VAS), Oswestry Disability Index, and modified MacNab criteria.

RESULTS

The mean age of the patients was 62.4 ± 10.9 years. The mean preoperative VAS score for low back, VAS score of the leg, and Oswestry Disability Index score was 5.1 ± 1.7, 7.4 ± 0.7, and 58.0 ± 8.4, respectively. These scores significantly improved to 1.8 ± 0.7, 1.5 ± 0.6, and 15.3 ± 7.1 at 12 months postoperatively, respectively (P < 0.01). Evaluation based on the modified MacNab criteria revealed that 95.0% of patients achieved a good-to-excellent outcome. One patient underwent revision surgery.

CONCLUSIONS

TELF emerges as a potentially safe and effective surgical option for alleviating radicular pain in patients with L5-S1 stable ILS combined with FS. While our short-term clinical results are satisfactory, it is necessary to expand the sample size and extend the follow-up time to validate the effectiveness and long-term efficacy of TELF.

Long-term Outcomes after Microsurgical Decompression of Lumbar Foraminal Stenosis and Adverse Effects of Preoperative Scoliosis: A Prospective Cohort Study

Lumbar foraminal stenosis is a common disorder, with surgical treatment varying from simple decompression to interbody fusion. It is often associated with degenerative lumbar scoliosis, but the effects of scoliosis on outcomes are unclear. The objectives of this study were to clarify long-term outcomes after microsurgical decompression of lumbar foraminal stenosis through Wiltse’s approach and to determine the effects of scoliosis on these outcomes. A total of 86 consecutive patients with lumbar foraminal stenosis were prospectively followed after microsurgical decompression. They were categorized in multiple subcohorts with follow-up durations ranging from 6 months to 5 years. Outcomes were assessed using the Short Form 36 questionnaire (average physical scores and bodily pain scores). Local Cobb angle of the operative segment was measured preoperatively, and its effects on outcomes were analyzed. Average physical scores improved significantly from 33.8 (95% confidence interval [CI]: 29.1–38.5) preoperatively to 59.5 (95% CI: 54.6–64.3) at 6 months postoperatively and remained improved for 5 years. Bodily pain scores improved significantly from 23.7 (95% CI: 18.7–28.6) preoperatively to 56.3 (95% CI: 51.2–61.6) at 6 months postoperatively and remained improved for 5 years. Patients with preoperative scoliosis (local Cobb angle >10 degrees) had poorer outcomes: average physical scores were worse by 9.6 points (p = 0.07) and bodily pain scores were worse by 12.1 points (p = 0.02), compared with patients without scoliosis (local Cobb angle ≤10 degrees). Microsurgical foraminal decompression produced overall excellent outcomes in patients with lumbar foraminal stenosis. Preoperative scoliosis attenuated these beneficial effects.