{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T09:07:17Z","timestamp":1779527237618,"version":"3.53.1"},"reference-count":62,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2016,2]]},"abstract":"<jats:p>Isthmic spondylolisthesis due to pars defects resulting from trauma or spondylolysis is not uncommon. Symptomatic patients with such pars defects are traditionally treated with a variety of fusion surgeries. The authors present a unique case in which such a patient was successfully treated with endoscopic discectomy without iatrogenic destabilization.<\/jats:p>\n                  <jats:p>A 31-year-old man presented with a history of left radicular leg pain along the distribution of the sciatic nerve. He had a disc herniation at L5\/S1 and bilateral pars defects with a Grade I spondylolisthesis. Dynamic radiographic studies did not show significant movement of L-5 over S-1. The patient did not desire to have a fusion. After induction of local anesthesia, the patient underwent an awake transforaminal endoscopic discectomy via the extraforaminal approach, with decompression of the L-5 and S-1 nerve roots. His preoperative pain resolved immediately, and he was discharged home the same day. His preoperative Oswestry Disability Index score was 74, and postoperatively it was noted to be 8. At 2-year follow-up he continued to be symptom free, and no radiographic progression of the listhesis was noted.<\/jats:p>\n                  <jats:p>In this case preservation of stabilizing structures, including the supraspinous and interspinous ligaments and the facet capsule, may have reduced the likelihood of iatrogenic instability while at the same time achieving symptom control. This may be a reasonable option for select patient symptoms confined to lumbosacral radiculopathy.<\/jats:p>","DOI":"10.3171\/2015.11.focus15512","type":"journal-article","created":{"date-parts":[[2016,2,1]],"date-time":"2016-02-01T03:36:55Z","timestamp":1454297815000},"page":"E4","source":"Crossref","is-referenced-by-count":6,"title":["Transforaminal endoscopic discectomy to relieve sciatica and delay fusion in a 31-year-old man with pars defects and low-grade spondylolisthesis"],"prefix":"10.3171","volume":"40","author":[{"given":"Karthik","family":"Madhavan","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lee Onn","family":"Chieng","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph P.","family":"Hofstetter","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Washington, Seattle, Washington; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael Y.","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery and the Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-focus15512","series-title":"World Neurosurg","first-page":"553.e5","article-title":"Anterior thigh compartment syndrome and local myonecrosis after posterior spine surgery on a Jackson table","volume":"78","author":"Ahmad","year":"2012"},{"key":"b2-focus15512","series-title":"World Neurosurg","article-title":"Comparison of outcomes of percutaneous endoscopic lumbar discectomy and open lumbar microdiscectomy for young adults: a retrospective matched cohort study","author":"Ahn","year":"2015"},{"key":"b3-focus15512","series-title":"Neurosurgery","first-page":"1600","article-title":"Adjacent segment degeneration after lumbar interbody fusion with percutaneous pedicle screw fixation for adult low-grade isthmic spondylolisthesis: minimum 3 years of follow-up","volume":"67","author":"Bae","year":"2010"},{"key":"b4-focus15512","series-title":"J Spinal Disord","first-page":"406","article-title":"Defects of pars interarticularis in athletes: a protocol for nonoperative treatment","volume":"6","author":"Blanda","year":"1993"},{"key":"b5-focus15512","series-title":"J Bone Joint Surg Am","first-page":"382","article-title":"Low-back pain in athletes","volume":"86-A","author":"Bono","year":"2004"},{"issue":"2","key":"b6-focus15512","series-title":"Neurosurg Focus","first-page":"E13","article-title":"Minimally invasive image-guided direct repair of bilateral L-5 pars interarticularis defects","volume":"25","author":"Brennan","year":"2008"},{"key":"b7-focus15512","series-title":"J Spinal Disord Tech","first-page":"58","article-title":"Biomechanical analysis of the disc adjacent to posterolateral fusion with laminectomy in lumbar spine","volume":"18","author":"Chen","year":"2005"},{"key":"b8-focus15512","series-title":"Am J Sports Med","first-page":"248","article-title":"Lumbar spondylolysis. A study of natural progression in athletes","volume":"25","author":"Congeni","year":"1997"},{"issue":"2 Suppl","key":"b9-focus15512","series-title":"J Neurosurg","first-page":"163","article-title":"Risk factors for adjacent-segment failure following lumbar fixation with rigid instrumentation for degenerative instability","volume":"90","author":"Etebar","year":"1999"},{"key":"b10-focus15512","series-title":"Childs Nerv Syst","first-page":"209","article-title":"L5 spondylolysis\/spondylolisthesis: a comprehensive review with an anatomic focus","volume":"29","author":"Foreman","year":"2013"},{"key":"b11-focus15512","series-title":"Spine (Phila Pa 1976)","first-page":"1023","article-title":"Serial changes in trunk muscle performance after posterior lumbar surgery","volume":"24","author":"Gejo","year":"1999"},{"key":"b12-focus15512","series-title":"Spine (Phila Pa 1976)","first-page":"1275","article-title":"L5-S1 segment survivorship and clinical outcome analysis after L4-L5 isolated fusion","volume":"28","author":"Ghiselli","year":"2003"},{"key":"b13-focus15512","series-title":"Clin Neurol Neurosurg","first-page":"29","article-title":"A minimally invasive approach to defects of the pars interarticularis: Restoring function in competitive athletes","volume":"139","author":"Gillis","year":"2015"},{"issue":"Suppl 1","key":"b14-focus15512","series-title":"Eur Spine J","first-page":"126","article-title":"Uninstrumented posterolateral spinal arthrodesis: is it the gold standard technique for I degrees and II degrees grade spondylolisthesis in adolescence?","volume":"18","author":"Girardo","year":"2009"},{"key":"b15-focus15512","series-title":"Spine (Phila Pa 1976)","first-page":"336","article-title":"Scoliosis research society outcome instrument in evaluation of long-term surgical results in spondylolysis and low-grade isthmic spondylolisthesis in young patients","volume":"30","author":"Helenius","year":"2005"},{"key":"b16-focus15512","series-title":"Spine (Phila Pa 1976)","first-page":"120","article-title":"Degenerative lumbar spondylolisthesis: an epidemiological perspective: the Copenhagen Osteoarthritis Study","volume":"32","author":"Jacobsen","year":"2007"},{"key":"b17-focus15512","series-title":"Clin Neurol Neurosurg","first-page":"84","article-title":"Technical considerations in transforaminal endoscopic discectomy with foraminoplasty for the treatment of spondylolisthesis: Case report","volume":"119","author":"Jasper","year":"2014"},{"key":"b18-focus15512","series-title":"Pain Physician","first-page":"E703","article-title":"Transforaminal endoscopic discectomy with foraminoplasty for the treatment of spondylolisthesis","volume":"17","author":"Jasper","year":"2014"},{"issue":"154","key":"b19-focus15512","series-title":"Clin Orthop Relat Res","first-page":"114","article-title":"Urogenital complications of anterior approaches to the lumbar spine","author":"Johnson","year":"1981"},{"key":"b20-focus15512","series-title":"Eur Spine J","first-page":"268","article-title":"To fuse or not to fuse in lumbar degenerative spondylolisthesis: do baseline symptoms help provide the answer?","volume":"21","author":"Kleinstueck","year":"2012"},{"key":"b21-focus15512","series-title":"J Orthop Sci","first-page":"270","article-title":"Spinal stenosis in grade I degenerative lumbar spondylolisthesis: a comparative study of outcomes following laminoplasty and laminectomy with instrumented spinal fusion","volume":"10","author":"Matsudaira","year":"2005"},{"key":"b22-focus15512","series-title":"J Biomech","first-page":"211","article-title":"Some mechanical properties of the third human lumbar interlaminar ligament (ligamentum flavum)","volume":"1","author":"Nachemson","year":"1968"},{"key":"b23-focus15512","series-title":"Spine (Phila Pa 1976)","first-page":"192","article-title":"Physiologic strains in the lumbar spinal ligaments. 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