Endoscopic procedure may be safe, successful treatment for lumbar spondylolysis
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Published results showed interlaminar percutaneous endoscopic pars decompression may be safe and successful among patients with stable lumbar spondylolysis and nerve root compression.
Researchers assessed clinical parameters related to outcomes, including the Oswestry Disability Index (ODI) and VAS for leg pain, among 11 patients with lumbar spondylolysis before and after interlaminar percutaneous endoscopic pars decompression. Researchers also preoperatively and postoperatively evaluated radiological outcomes, vertebral slippage percentage and motion radiographs.
Results showed 63.3% of patients achieved more than 50% improvement in the ODI score and 90.91% of patients achieved more than 50% improvement in VAS score at a mean follow-up of 22.64 months. Researchers found patients who spondylolysis with vertebral slippage had inferior ODI improvement outcomes vs. patients with spondylolysis alone. However, researchers noted no significant difference in VAS pain score between the groups. Although researchers observed no significant difference in the slippage percentage between the preoperative and postoperative periods, one patient experienced vertebral slippage after surgery but did not require fusion surgery.
Perspective
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The authors should be commended for evaluating a novel minimally invasive technique for treating a common spinal condition. Minimally invasive approaches that reduce blood loss, pain, risk of infection and damage to native tissue can be of great benefit to patients. While these initial results are promising, further study is necessary to determine if such treatment is equivocal to other minimally invasive approaches, such as transforaminal decompression. The authors made comment regarding the risks of increasing vertebral instability following a transforaminal approach due to iliolumbar ligamentous injury; however, in this present study, of six patients with vertebral slippage preoperative, one patient had increased slippage postoperative attributed to iliolumbar ligament injury. Thus, such a conclusion may be too early to determine. Additionally, recommending against spinal fusion in cases of vertebral slippage may be misleading, as the patients in the study averaged 8% slippage and lacked true dynamic instability. Overall, this is an interesting study but possesses several limitations that require further evaluation before drawing definitive conclusions.
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