Percutaneous Transforaminal Endoscopic Surgery (PTES) and mini-incision L5/S1 OLIF with self-lock cage for surgical treatment of L5 spondylolisthesis

Abstract

Abstract Objectives We designed Percutaneous Transforaminal Endoscopic Surgery (PTES) technique under local anesthesia and L5/S1 OLIF (OLIF51) with self-lock cage through mini-incision for the treatment of L5 spondylolisthesis. The purpose of study is to evaluate the feasibility, efficacy and safety of this method. Methods Thirteen cases of L5 spondylolisthesis with nerve root symptoms were included in this study. The patients underwent PTES under local anesthesia in a prone position, and then OLIF51 with self-lock cage and allograft was performed through left abdominal mini-incision and oblique retroperitoneal approach between bilateral iliac vessels with the external oblique, internal oblique and transverse abdominal muscles bluntly separated in turn for L5/S1 in a right oblique position under general anesthesia. Back and leg pain were preoperatively and postoperatively evaluated using VAS, and the clinical outcomes were evaluated with ODI before surgery and at 2-year follow-up. Anterior and posterior intervertebral space height, lumbar lordotic angle, and operative segmental lordotic angle were measured on lumbar spine X-rays preoperatively and postoperatively. The fusion status was assessed according to the Bridwell’s fusion grades. Results The operation duration was 49.1 ± 5.6 minutes for PTES and 73.6 ± 8.2 minutes for OLIF. There was a blood loss of 25(15–45) ml. The incision length was 7.5 ± 1.1 mm for PTES and 46.8 ± 3.8 mm for OLIF. The hospital stay was 5(4–6) days. The follow-up duration was 29(24–37) months. For the clinical evaluation, the VAS of back and leg pain significantly dropped after surgery (p < 0.001) and the ODI significantly decreased from 64.7 ± 7.8% to 12.9 ± 4.3% 2 years after surgery (p < 0.001). Anterior and posterior intervertebral space height, and operative segmental lordotic angle significantly improved after surgery (p < 0.05). Fusion grades based on the Bridwell grading system at 2-year follow-up were grade I in 9 segments (69.2%), grade II in 4 segments (30.8%). No patients had any form of permanent iatrogenic nerve damage and a major complication. No failure of instruments was observed. Conclusions PTES and mini-incision OLIF51 with self-lock cage is a good choice of minimally invasive surgery for L5 spondylolisthesis, which can get direct neurologic decompression and satisfying fusion, and hardly destroy the rectus abdominis and its sheath, paraspinal muscles and bone structures.