Decompression Surgery For Lumbar Spondylolysis Without Fusion: A Review Article

The various techniques reported in the literature for surgical treatment of lumbar spondylolysis can be grouped into three categories: direct repair of the lysis, lumbar inter-segmental fusion, and decompression. Direct repair of spondylolysis has been widely used to treat young patients in whom severe disc degeneration and instability are not apparently combined. When severe disc degeneration causing low back pain and/or instability is observed, lumbar intersegmental fusion has been performed. Gill et al. (1955) were the first to describe non-fusion decompression surgery in patients with radiculopathy due to lumbar spondylolysis. The short-tem clinical results were reported to be good. However, some authors have reported that Gill's laminectomy results in further postoperative vertebral slippage. Biomechanically, finite element analysis revealed that disc stress increased 2-fold after Gill's laminectomy. This increased disc stress after surgery may facilitate disc degeneration, which may lead to slippage. Recently, we developed a procedure for minimally invasive decompression of the nerve root affected by lumbar spondylolysis that is carries out using a spinal endoscope. Finite element analysis showed that endoscopic decompression did not change the lumbar kinematics in terms of disc stresses after surgery. CONVENTIONAL DECOMPRESSION SURGERY (GILL'S LAMINECTOMY)