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Current surgical philosophy by traditionally trained spinal surgeons focuses on decompression with or without fusion as the “ultimate cure” for a painful spinal segment. Endoscopic surgery-the least invasive of current minimally invasive surgical options—focuses on treating the patho-anatomy of the pain generator. Spondylolisthesis is traditionally represented as a “gold standard” for fusion, but with minimally invasive techniques evolving, there is a new path between traditional open decompression and fusion that offers an alternative. A review of a database of patients who refused fusion, but opting to an endoscopic decompression with sciatica, even in the face of back pain determined that transforaminal decompression for a disc herniation or foraminal stenosis is effective in some patients and result in a decrease in the need for fusion.
The endoscopic transforaminal decompression technique is discussed as a stand-alone or staged procedure that may reduce the number of surgical fusions in the face of degenerative and isthmic spondylolisthesis. When combined with surgical rhizotomy for low back pain, this hybrid procedure includes rhizolysis for posterior column back pain, may offer a cost-effective method for treating common debilitating chronic low back pain.