Surgical management of spondylolysis and minimally displaced lytic spondylolisthesis (LS) are indicated on the extent of pain and only when non-operative management has failed. The prevalent practise of suggesting that spine is unstable or will fall over does not have any biomechanical or natural history basis. The not so common developmental spondylolisthesis’ surgical strategy is based on whether the patients is skeletally mature (as growth spurt may rapidly progress the listhesis) and on balance of the spinal column.
Once surgical intervention for lytic spondylolisthesis is decided on, after a shared-decision making process with the patient, the surgical considerations are 1) Repair of the Pars alone in absence of listhesis and good disc height preservation 2) Avoid anterior lumbar fusion as the strong Anterior longitudinal ligament is cut, making it difficult to control distracting height and stability 3) For exactly that reason (2 above), Total Disc Replacements are contraindicated 4) Postero lateral fusion does not work due to lack of bone stock to achieve fusion; hence a posterior interbody fusion works best 5) limited role for decompression (Laminectomy) alone and finally 6) Issues of lordosis and whether to fully reduce or fuse in situ remain unresolved.
The surgical principles for lytic spondylolisthesis are somewhat different from that for degenerative spondylolisthesis (DS), the other very common spondylolisthesis, where a posterolateral fusion (Without interbody fusion) may well work. Studies have also demonstrated superiority of decompression alone when compared with fusion for leg pain associated DS.
The talk will demonstrate the latest technology used to achieve minimally invasive spinal fusion at L5-S1 using MAS-TLIF™ system (Nuvasive Inc) along with operative O-Arm 3-D imagery (Medtronic) with Stealth Navigation (Medtronic Inc) with Neurovison NM5 monitoring (Nuvasive Inc), Orthoblend de-mineralised bone matrix (Medtronic) and finally using novel spondylolisthesis reducing tool (Nuvasive). A review a small cohort of patients with images will be undertaken.