epending on the symptoms (pure nerve root compression vs.

mechanical pain due to

segmental instability) different operative techniques are available. Simple minimally invasive
microdecompression via a very small incision is often successful in low grade slips with a
single root involvement. This operation can be achieved through a mini-open microscopic or
endoscopic approach releasing the pressure on the traversing and exiting roots through
subarticular decompression in the lateral recess. The more classical approach for a definitive
posterior fusion and instrumentation is described below:
Through the posterior midline approach, the lumbodorsal fascia is divided, and a
subperiosteal dissection of erector spinae muscles is performed over the posterior elements of
the involved vertebrae (typically L5 and S1).
Some surgeons prefer the harvesting of iliac crest autograft prior to the fascial opening. This
can be performed through the same incision on one or both iliac crests in lumbosacral fusion
operations. The fascia overlying the crest is opened. Care is taken to preserve the integrity of
the sacroiliac joints. The thickest area for obtaining cancellous bone is decorticated and
multiple gouges are used to retrieve the autograft. Hemostasis is obtained and the fascia is
closed over a drain.
In type IIa (lytic) slips, the spondylolysis can often be observed by palpation with the
hypermobility of the L5 posterior elements and the incompetent pars. The lateral exposure is
extended past the lateral facets and