Translaminar Approach To Herniated Lumbar Discs In Old Patients With Degenerative Spondylolisthesis

In increasing frequency, we are confronted with very old patients presenting with symptomatic degenerative spinal diseases. Many of these patients have significant comorbidity and minimally invasive treatment strategies are desirable. We report the case of an 87-year old woman with intolerable radicular pain caused by large disc herniation with intraforaminal extension in the presence of degenerative spondylolisthesis. Due to significant comorbidity, a translaminar approach was chosen for microdiscectomy to limit the duration of surgery, avoid arthrectomy and, therefore, minimize the risk of increasing hypermobility. After 6 months, the patient was free of pain, imaging studies showed an unchanged degree of spondylolisthesis. In patients with lumbar disc herniation and degenerative spondylolisthesis with significant comorbidity, a translaminar approach should be considered as an alternative to decompression and instrumentation in order to minimize the operative risk and retain the maximum possible stability.