Transforaminal Endoscopic Decompression in the Setting of Lateral Lumbar Spondylolisthesis

BACKGROUND: Lateral subluxation of the vertebra is commonly seen in degenerative lumbar scoliosis. Transforaminal endoscopic spine surgery is an emerging technique in spine surgery but has never been described as a treatment option for lumbar radiculopathy in the setting of lateral lumbar spondylolisthesis. METHODS: A technique for endoscopic treatment of lumbar disc herniation in the setting of lateral spondylolisthesis is presented. We retrospectively reviewed 199 cases of patients who underwent transforaminal endoscopic surgery in a 3-year period with a minimum follow-up of 1 year. RESULTS: Between 2014 and 2017, 4 patients (average age, 74.8 years; range, 69-82 years) underwent transforaminal endoscopic discectomy procedures for disc herniations at the level of lateral subluxation. One patient whose lateral subluxation was above an instrumented fusion required an extension of fusion to the operated level 5 months after endoscopic surgery for a reherniation. For the other 3 patients, mean visual analog scale score for radicular pain improved from an average pain score of 8.3 before surgery to 3.0 1 year after surgery, and Oswestry Disability Index improved from 26.7 to 4.7. CONCLUSIONS: Transforaminal endoscopic surgery for lumbar disc herniation in the setting of lateral subluxation of vertebral bodies is a unique minimally invasive approach for treatment of lumbar radiculopathy that might be considered as an alternative treatment to deformity correction surgery in older patients.