Treatment of Degenerative Lumbar Spondylolisthesis with Endoscopic Decompression of the Lumbar Spinal Canal

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Degenerative spondylolisthesis is a common problem in the elderly. Theassociated spinal stenosis in the central canal and the foramina may cause sciatica-typeclaudication symptoms affecting the lower back and extremities. Walking endurance istypically reduced. Eventually, patients may decide on surgical decompression ifconservative care measures, including spinal injections, physical therapy, activitymodifications, and pain medication, no longer provide relief. In the elderly, extensivespine surgery is always of concern regarding operation length, blood loss, postoperativepain management, and medical comorbidities whose management may easily spin outof control following major spine surgery. In a small subset of spondylolisthesispatients, decompression alone may suffice, particularly in those where the spinalmotion segment has become rigid due to endstage degenerative disc disease, verticalcollapse, and auto fusion. On the other hand, stenosis is often severe in these types ofpatients, for which reason extensive decompression may be necessary, andpostoperative iatrogenic instability may ensue. In this article, the authors present thetechnique of endoscopic canal and foraminal decompression in patients with suchadvanced spondylolisthesis. They discuss the technical caveats and limitations of theprocedure.