Single Prone Position, Dual Surgeon Simultaneous Navigated Prone Lateral Interbody Placement with Endoscopic Laminectomy for Symptomatic Immobile Spondylolisthesis

Abstract Symptomatic immobile spondylolisthesis with severe circumferential stenosis consisting of foraminal, lateral recess, and central canal narrowing secondary to disc height loss and facet arthropathy typically may require direct decompression followed by fixation given the need for complete facetectomies to adequately release exiting nerve roots. Recent evidence suggests that standalone grafts may offer a favorable risk profile for indirect decompression in cases with appropriate spinal alignment and normal bone density. A 54-year-old female presented with a one-year history of neurogenic claudication and a bilateral L4 radiculopathy with paresthesia and pain. Symptoms were refractory to aggressive medical management. On exam, she had pain limited weakness in her bilateral dorsiflexors and plantar flexors. She had decreased sensation to light touch below her knees, and she had hyporeflexia of her patellar tendon reflexes bilaterally. This innovative approach presents the first single position, dual surgeon simultaneous navigated prone lateral standalone graft placement with endoscopic unilateral laminectomy for bilateral decompression (ULBD) for symptomatic immobile spondylolisthesis without the need for augmentation with posterior fixation. This approach should be further evaluated in a larger cohort of patients.