Partial Pediculectomy for Spondylolisthesis with Radicular Pain Combined with Severe Osteoporosis

하지 방사통과 심한 골다공증을 동반하는 척추전전위증을 위한 척추경 부분절제술

Objective : For relief of back pain related to spondylolisthesis, fusion with or without internal fixation may be necessary. Currently, bilateral wide posterior decompression and fusion with or without internal fixation are used for treatment of spondylolisthesis. In case of severe osteoporosis, discectomy may be done without fusion to decompress the nerve roots. However, the procedure may aggravate radicular symptom because slippage may increase and thus foramen may become narrower. In these settings, inferomedial partial pediculectomy has been done in our institution, The object of this study was to evaltuate such cases with regard to per- and postoperative clinical courses. Patients and Methods : Fifteen patients complaining radicular pain with mild or no back pain underwent inferomedial partial pediculectomy. It was done in lytic spondylolisthesis after extension of isthmic defect. In degenerative spondylolisthesis of L4-5 interspace, intertransverse pediculectomy was done via paraspinal approach not to injure the posterior segment with intact isthmus. But, in degenerative spondylolisthesis of L5-S1 interspace however, partial pediculectomy was done after making artificial isthmic defect via midline approach. Then, reconstructive laminoplasty of L5 was performed to avoid iatrogenic instability resulted from artificial isthmic defect. They were followed up for average 14.4 months(3-31 months). Results : Radiating pain was relieved in all cases(100%). Postoperative result was excellent in 7 cases(46.7%), good in 7(46.7%) and fair in 1(6.6%). Only 1 case(6.7%) showed increase in slippage during follow-up period. Conclusion : Inferomedial partial pediculectomy is considered as a useful procedure for severely osteoporotic patients with spondylolisthesis with regards to keeping stability and decompressing the nerve roots.