Abstract

۱٫ Introduction

۲٫ Pathophysiology

۳٫ Diagnosis

۴٫ Management of spondylolisthesis

۵٫ Conclusion

Ethical approval

Author contribution

Funding

References

Abstract

Background

     Spondylolisthesis refers to anterior displacement of the vertebral body in reference to the bordering vertebral bodies, causing segmental instability, that mostly occurs in the middle lumbar spine and the lumbosacral junction. If surgery is indicated, open technique with lumbar pedicle strew instrumentation is the standard therapy. Recently, minimally-invasive technique can be applied in spondylolisthesis surgery using percutaneous long-arm pedicle screws with a promising short- and long-term outcome.

Objective

     This paper reviews the development of minimally-invasive percutaneous long arm pedicle screws from techniques to reported outcomes.

Conclusion

     Minimally-invasive surgery utilizing advance techniques and instrumentations can give a better outcome in spondylolisthesis surgery associated with lesser blood loss, pain level, and length of hospitalization.

Introduction

     Spondylolisthesis refers to anterior displacement of the vertebral body in reference to the bordering vertebral bodies, causing segmental instability. There are 6 broad categories depending on its etiologic cause, including isthmic, traumatic, degenerative, pathologic, dysplastic, and postsurgical. The most common occurrence is the degenerative spondylolisthesis, which affect elderly patients with mean age ranging from 71.5 years to 75.7 years with higher prevalence in female. Degenerative spondylolisthesis most commonly affects the lower lumbar spine, although cervical and thoracic spine involvement have been reported secondary to trauma [1]. It is one of the most common cause of low back pain in United States, affecting around 11.5% population [2].

     Controversy exists regarding the optimal management strategy for patients with spondylolisthesis [3]. Patients with symptomatic pain may be first treated with conservative management such as non-narcotic and narcotic medications, steroid injections, and physical therapy. If there’s failure in conservative management, surgery is appropriate [2]. The standard treatment is open pedicle fixation and spinal fusion to address the instability, or open decompression and in situ fusion to decompression purpose only. However, open techniques have been associated with extensive blood loss and soft tissue dissection, which further lead to more post-operative pain, lengthy hospitalization and higher cost. Minimally-invasive percutaneous spondylolisthesis reduction technique offers solutions to overcome those tissue dissection-related outcomes.

Conclusion

     The recently developed minimally invasive technique to reduce spondylolisthesis is a promising advance in spinal surgery. This technique is safe and feasible to use with lesser soft tissue dissection, blood loss, post-operative pain and length of hospitalization. Further research to reduce the financial burden to patients is needed especially for the application in developing countries.