The inferior facets of L5 (along with the entire lamina) are “disconnected” from the pedicles of L5 by the bilateral pars fractures. When doing a “minimally invasive” approach, you do not have access to the center of the spine. The surgeon can remove the free-floating facets from the free-floating lamina but cannot remove the entire lamina as this approach from both sides will not allow access to the entire lamina. This then prevents access to removing the entire free-floating lamina-facet complex and the quantity of bone graft is significantly diminished.
As I have said before, the minimally invasive approach is more of a marketing tool. It is not minimally invasive as if you add up the length of the incisions and the dissection, the incision for “minimally invasive surgery” is almost twice as long as a minimally open procedure with a lesser success rate. Nonetheless, a good MIS surgeon can have a good result.
Dr. Corenman
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.