J Minim Invasive Spine Surg Tech.  2022 Apr;7(1):28-36. 10.21182/jmisst.2021.00332.

Full-endoscopic Foraminotomy in Degenerative Spondylolisthesis: A “Module-based” Approach for Surgical Planning and Execution

• Isseldyk FV
• Lim WJ
• Kim YJ
• Kim JH
• Ryu KS
• Liu Y
• Kim JS

• KMID: 2562115
• DOI: http://doi.org/10.21182/jmisst.2021.00332

Abstract

Purpose
Degenerative Lumbar Spondylolisthesis (DSL) is a common spinal pathology characterized by the anterior slippage of one vertebral body on another. DSL is caused mainly by degeneration of the intervertebral disc in the first place, with subsequent degeneration of the facet joints that end causing the slippage. As the disease evolves, stability is restored as a result of advanced degeneration and disc collapse. But while this natural evolution takes place, DSL may produce radicular symptoms by different mechanisms. To present a “module-based” approach for the surgical planning and execution of full-endoscopic foraminotomy in DSL, combined with case examples of the most common surgical scenarios.
Methods
We propose a “module-based surgery” using the standard endoscopic foraminotomy technique as a baseline. According to the patient’s clinical and imaging characteristics, several “modules” can be added. The resulting endoscopic surgery is a summation of the basic endoscopic foraminotomy plus all the additional required modules.
Results
Surgical modules description and case examples are provided.
Conclusion
Transforaminal lumbar endoscopic foraminotomy represents a minimally invasive technique to treat foraminal and combined foraminal-lateral recess stenosis. DSL and its multiple scenarios represent a challenge to the endoscopic surgeon. Module-based approach can help systematize and execute these demanding endoscopic procedures.

Keyword

Endoscopic; Foraminotomy; Lumbar; Spondylolisthesis; Minimally; Invasive