Lumbar Spondylolisthesis: Latest Minimally Invasive Treatments

Q: Lumbar Spondylolisthesis: Latest Minimally Invasive Treatments

Hello： <br>1. <br>The OLIF procedure you mentioned is relatively novel, and its advantages are generally as you described. <br>However, it should be noted that OLIF accesses the spine from the anterolateral approach and employs an indirect decompression technique, which means it

Spinal instability due to spondylolisthesis?

Hello, Director Lai.
I am an RA.
MRI shows L4-5 spondylolisthesis with spinal instability, herniated disc compressing the nerve, and narrowing of the intervertebral space.
Symptoms include lumbar pain, right lower limb neuropathic pain, and limited mobility.
I currently have options for oblique lumbar interbody fusion (OLIF) and 3D computer-assisted minimally invasive spinal fusion surgery.
I would like to ask:
1.
Is oblique lumbar interbody fusion (OLIF) the latest minimally invasive lumbar surgery? Is it performed through the lateral approach via the lumbar muscles? Its advantages include not damaging the bone, not stripping the muscles, and not retracting the nerves, correct?
2.
Regarding the 3D computer-assisted minimally invasive spinal fusion surgery, which emphasizes the precise placement of screws, its advantages include less bleeding, minimal tissue disruption, faster recovery, and reduced infection risk.
However, it requires a high out-of-pocket cost of 350,000 NTD.
If it is beneficial for RA, I can accept it, but there are also advantages to minimally invasive techniques.
Is there a reason why the materials or equipment used, such as screws and implants, are more expensive? What is the reason for patients to choose navigation?

Amin, 50~59 year old female. Ask Date: 2022/05/26

Dr. Lai Zhaokang reply Neurosurgery

Hello:
1.
The OLIF procedure you mentioned is relatively novel, and its advantages are generally as you described.
However, it should be noted that OLIF accesses the spine from the anterolateral approach and employs an indirect decompression technique, which means it may not achieve direct decompression (i.e., the complete and direct removal of the compressive lesions affecting the nerves).
Additionally, many spinal patients have sources of nerve compression that involve both anterior and posterior elements or originate from the posterior side.
Therefore, the efficacy of OLIF may be limited for these types of patients.
It is essential to have a professional spinal surgeon evaluate the situation (a good surgery may not necessarily be suitable for you; both subjective and objective conditions need to be assessed).
2.
Currently, most routine surgeries for patients utilize 2D navigation, which has been well-established in spinal surgery for decades.
The newer 3D navigation is certainly beneficial, primarily in reducing radiation exposure for both patients and healthcare providers.
As for minimally invasive implantation of screws, both 2D and 3D navigation can be executed smoothly and accurately, with minimal differences.
The key factor remains the skill and experience of the operating surgeon.
3D navigation simply provides multiple reference coordinate axes during the procedure.
However, patients may need to pay extra for this.
3.
Regarding materials, OLIF requires specific bone graft materials that are out-of-pocket expenses.
For minimally invasive screw implantation, both 2D and 3D navigation can share the same bone graft materials, but some costs will also need to be covered by the patient.
4.
Patients with rheumatoid arthritis often have associated osteoporosis, which can affect the stability of the screws.
Please ensure your doctor is aware of this.
Best wishes from Dr.
Lai Chao-Kang, Chief of Spine Surgery at Changhua Hospital.

Reply Date: 2022/05/26

More Info

Understanding lumbar spondylolisthesis and its treatment options is crucial for managing your condition effectively. Lumbar spondylolisthesis occurs when one vertebra slips forward over another, leading to instability in the spine. This condition can result in symptoms such as lower back pain, nerve compression, and radiating pain into the legs, as you've described. Your MRI findings indicate that you have L4-5 spondylolisthesis, disc herniation, and spinal stenosis, which can significantly impact your quality of life.

1. OLIF (Oblique Lateral Interbody Fusion) as a Minimally Invasive Technique
OLIF is indeed one of the latest advancements in minimally invasive spinal surgery. This technique involves accessing the spine through the side of the body, allowing surgeons to avoid major muscle groups and reduce trauma to the surrounding tissues. The primary advantages of OLIF include:
- Preservation of Muscle and Bone: By approaching the spine laterally, OLIF minimizes damage to the muscles and bones, which can lead to faster recovery times and less postoperative pain.

- Reduced Risk of Nerve Injury: The lateral approach allows for better visualization and access to the intervertebral disc space without directly manipulating the nerves, thereby reducing the risk of nerve injury.

- Improved Recovery: Patients often experience quicker recovery times and shorter hospital stays compared to traditional open surgeries.

OLIF is particularly beneficial for patients with lumbar spondylolisthesis, as it allows for effective stabilization of the spine while minimizing the risks associated with more invasive procedures.

2. 3D Computer Navigation in Minimally Invasive Spine Surgery
3D computer navigation technology enhances the precision of spinal surgeries, including fusion procedures. This technology allows surgeons to visualize the spine in three dimensions, improving the accuracy of screw placement and other instrumentation. The benefits of using 3D navigation include:
- Precision in Instrumentation: Surgeons can place screws and rods with greater accuracy, which is crucial for the stability of the fusion.

- Reduced Blood Loss and Tissue Damage: Minimally invasive techniques, combined with navigation, typically result in less blood loss and damage to surrounding tissues.

- Faster Recovery: Patients often experience quicker recovery times, allowing them to return to their daily activities sooner.

The higher costs associated with 3D navigation surgeries can be attributed to the advanced technology and equipment used, which may include specialized imaging systems and software. While the upfront costs may be significant, the potential for reduced complications and faster recovery can make it a worthwhile investment for many patients.

Conclusion
Both OLIF and 3D computer navigation represent significant advancements in the treatment of lumbar spondylolisthesis. They offer minimally invasive options that can lead to better outcomes, reduced recovery times, and lower risks of complications. Given your symptoms and MRI findings, discussing these options with your spine surgeon is essential. They can provide personalized recommendations based on your specific condition, overall health, and treatment goals.

It's important to weigh the benefits and risks of each procedure, considering factors such as your age, activity level, and personal preferences. Engaging in a thorough discussion with your healthcare provider will help you make an informed decision that aligns with your needs and lifestyle.

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