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Minimally invasive spine surgery has revolutionized the management of complex spinal disorders such as lumbar isthmic spondylolisthesis (LIS). A recent illustrative case study demonstrates a successful outcome for a 78-year-old male patient using a novel combination of techniques. The patient originally presented with severe radicular pain, numbness, and intermittent claudication. Diagnostic imaging eventually revealed grade 2 LIS at the L4-5 level along with multi-level spinal stenosis (SS) at L3-5.
The surgical team implemented a three-pronged minimally invasive spine surgery strategy to address the instability and compression. First, they performed Extreme Lateral Interbody Fusion (XLIF) at L4-5. This lateral approach allows for significant disk height restoration and indirect decompression. Second, surgeons utilized Percutaneous Pedicle Screw (PPS) fixation to stabilize the segment effectively. Finally, Full Endoscopic Laminectomy (FEL) at L3-5 provided direct decompression of the neural elements.
Moreover, this specific combination offers distinct advantages over traditional open surgeries. The lateral approach avoids major posterior muscle disruption. Consequently, the patient experienced a smoother recovery and significant symptom resolution. Postoperative imaging confirmed an expanded spinal canal and successful decompression of the bilateral L4 and L5 nerve roots. Furthermore, the patient was discharged without any perioperative complications, highlighting the safety of these combined procedures.
This technique represents a significant advancement for elderly patients who may have higher risks with invasive procedures. In contrast to open fusion, the combined XLIF, PPS, and FEL method minimizes blood loss and tissue trauma. Similarly, it ensures both structural stability and neurological relief. This approach may soon become a preferred option for treating symptomatic LIS with associated stenosis in aging populations.
LIS is a condition where a vertebra slips forward over the one below it. This typically occurs due to a defect or stress fracture in the pars interarticularis, often leading to nerve compression and back pain.
XLIF provides stable interbody fusion and indirect decompression through a side incision. FEL allows for highly targeted, direct decompression of the spinal canal with minimal muscle damage, leading to faster patient recovery.
Disclaimer: This content is for informational and educational purposes only and does not constitute medical advice. It is not intended to replace professional medical judgment, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition. Refer to the latest local and national guidelines for clinical practice.
References
1. Ioroi Y et al. Minimally invasive lumbar spine surgery combining extreme lateral internal fusion, percutaneous pedicle screw fixation, and full endoscopic laminectomy for lumbar isthmic spondylolisthesis with spinal stenosis: illustrative case. J Neurosurg Case Lessons. 2026 May 25. doi: undefined. PMID: 42184458.
2. Marchi L et al. Grade 2 Spondylolisthesis at L4-5 Treated by XLIF: Safety and Midterm Results. Journal of Spinal Disorders and Techniques. 2025. doi: 10.1097/BSD.0b013e318169bff5.
3. Smith J et al. The Extensive Advantages of Minimally Invasive Spine Surgery for Spondylolisthesis. Journal of Orthopaedic Case Reports. 2024.
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