14/10/2024
Speaking as a surgeon who does biportal endoscopic spine surgery, I'd like to add that fusion really is an option that's reserved for patients whose main problem is mechanical spine instability pain. Patients with JUST radiculopathy from nerve compression - even those who have compression from clinically stable spondylolisthesis (i.e., no complaint of significant instability pain) - improve with decompression treatment ALONE, for as long as the decompression was adequate AND the decompression technique did not introduce added instability to the spine.
Even in cases of degenerative spondylolisthesis with stenosis, it's been shown that the spinal mechanical construct does not progress to clinically significant instability if the surgical approach did not sacrifice critical support structures (i.e., facet joints, midline osseous-ligamentous complex, multifidus muscles).
So if there's no PRE-operative clinically significant instability, why do a fusion, right?
And if the surgical technique can achieve adequate decompression WITHOUT creating any instability that will require fusion, then why do fusion?
CONTENT0:00 Comment question from a viewer: is spinal fusion surgery needed for spondylolisthesis with stenosis? 0:45 This is an area in which orthopedic spi...
