Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI.
The Warren Alpert Medical School of Brown University, Providence, RI.
Pain Physician. 2020 Nov;23(6):E629-E636.
A severe grade I and grade II spondylolisthesis at L5-S1 creates an anatomic distortion that can compress the traversing S1 nerve with a retropulsed S1 vertebral body endplate and (sometimes) herniated disc.
To evaluate the feasibility for awake, endoscopic treatment of symptomatic radiculopathy secondary to the deformity that results from the retropulsed superior endplate of S1 in grade I/II L5-S1 spondylolisthesis in patients with and without previous fusion surgery.
Retrospective chart review.
This study took place in a single-center, academic hospital.
In 325 patients over 4 years there were 19 patients (8 with previous L5-S1 fusions and 11 without) treated with transforaminal endoscopic spine surgery for decompression of the neural foramen at L5-S1 in the setting of spondylolisthesis (at least 5 mm) and a retropulsed superior vertebral endplate of S1.
The average preoperative Visual Analog Scale (VAS) back and leg scores were 6.1 and 6.7, and the average preoperative Oswestry Disability Index (ODI) score was 50.4. The average 1-year VAS back and leg scores were 2.2 and 2.2, and the average 1-year postoperative ODI score was 20.5. There was no statistically significant difference between the fusion and nonfusion groups. Patients treated were patients who presented with an S1 or L5 and S1 radiculopathy as their primary complaint and a L5-S1 spondylolisthesis of 5 mm or greater. Patients treated had no instability on flexion-extension x-rays. Eleven patients had not had fusions at L5-S1, and 8 patients had previous fusions at L5-S1 but still had a spondylolisthesis of at least 5 mm. The average slip for nonfusion patients was 8.4 mm, and the average slip for fusion patients was 8.8 mm. At 1-year follow-up the improvement in VAS back scores was 44% in the nonfusion group and 49% in the fusion group, and the improvement in VAS leg scores was 84% in the nonfusion group and 58% in the fusion group. At 1-year follow-up the improvement in ODI scores was 63% in the nonfusion group and 54% in the fusion group.
Retrospective case series.
Awake, endoscopic surgery for the treatment of radiculopathy in the setting of a grade I/II L5-S1 spondylolisthesis is a viable minimally invasive treatment option for patients with radiculopathy in the setting of a stable L5-S1 spondylolisthesis with foraminal narrowing caused by a retropulsed superior endplate of the S1 vertebral body.
L5-S1 处严重的 I 级和 II 级脊椎滑脱会导致解剖学畸形，可压迫穿行的 S1 神经根，使其与 S1 椎体终板的逆行突出和（有时）椎间盘突出。
评估在伴有和不伴有先前融合手术的情况下，对 I/II 级 L5-S1 脊椎滑脱导致 S1 上终板逆行引起的畸形引起的神经根症状性放射痛进行清醒内镜治疗的可行性。
回顾性图表审查。
本研究在单中心学术医院进行。
在 4 年期间，共有 19 名患者（8 名有 L5-S1 融合史，11 名无）接受经椎间孔内镜脊柱手术治疗，以在脊椎滑脱（至少 5 毫米）和 S1 椎体上终板逆行的情况下，在 L5-S1 处进行神经孔减压。
术前平均视觉模拟量表（VAS）背部和腿部评分分别为 6.1 和 6.7，术前平均 Oswestry 残疾指数（ODI）评分为 50.4。术后 1 年平均 VAS 背部和腿部评分分别为 2.2 和 2.2，术后 1 年平均 ODI 评分为 20.5。融合组和非融合组之间无统计学差异。接受治疗的患者为主要表现为 S1 或 L5 和 S1 神经根病变且 L5-S1 脊椎滑脱为 5 毫米或更大的患者。接受治疗的患者在屈伸位 X 线片上无不稳定。11 名患者 L5-S1 处未融合，8 名患者 L5-S1 处有融合史，但仍有至少 5 毫米的脊椎滑脱。非融合患者的平均滑脱为 8.4 毫米，融合患者的平均滑脱为 8.8 毫米。在 1 年随访时，非融合组 VAS 背部评分改善 44%，融合组改善 49%，非融合组 VAS 腿部评分改善 84%，融合组改善 58%。在 1 年随访时，非融合组 ODI 评分改善 63%，融合组改善 54%。
回顾性病例系列。
在稳定的 L5-S1 脊椎滑脱伴有由 S1 椎体上终板逆行引起的神经孔狭窄的情况下，对 I/II 级 L5-S1 脊椎滑脱引起的神经根病进行清醒内镜手术是一种可行的微创治疗选择。
