Long Term Result of Pediculectomy in Symptomatic Isthmic Spondylolisthesis with Severe Osteoporosis

ABSTRACT

OBJECTIVE: Patients with symptomatic root compression in isthmic spondylolisthesis are commonly treated by bilateral wide posterior decompression and concomitant fusion with transpedicular instrumentation. But, in cases associated with severe osteoporosis or poor general conditions for surgery, high fusion failure rate or high operation risk is expected. The authors report the results of partial pediculectomy for root decompression without fusion procedure in 7 cases. Followed up period was over 3 years. METHODS: From December 1993 to May 1998, we performed operation in 87 patients with isthmic spondylolesthesis. Posterior lumbar interbody fusion was performed in 80 cases. Unilateral or bilateral removal of about 3mm length of infero-medial part of pedicle was performed in six cases who were associated with severe osteoporosis(T < -3.0 , BMD) and in 1 case with high risk cardiac disease. RESULTS: Radiating pain disappeared immediately after the surgery in all cases. There were no increasing instability after surgery. In long-term follow up, aggravation of symptoms were observed in 3 cases. In one of these 3 patients(high risk cardiac disease patient) bilateral wide decompression and bone fusion with transpedicular screwing was performed. CONCLUSION: In the surgical treatment of osteoporotic isthmic spondylolisthesis with foraminal stenosis in which transpedicular screwing and fusion is not indicated, partial pediculectomy without stabilization may be a effective method for relieving radicular pain, but in part of these patients symptoms may recur in long-term follow up.