Uniportal endoscopic decompression without fusion for grade II-III degenerative spondylolisthesis in the elderly: a case series.

Higher-grade degenerative lumbar spondylolisthesis in the elderly presents a significant management challenge. Standard treatment often involves surgical fusion, which provides stability but carries substantial morbidity in this vulnerable population. Decompression alone is less invasive but lacks strong evidence for these specific grades. This case series reports on facet-sparing uniportal endoscopic decompression as a less invasive alternative in three carefully selected elderly patients (>75 years old) with stable Grade II/III degenerative slips and neurogenic symptoms. All patients experienced rapid postoperative recovery, were discharged the same day and had minimal complications. At 6- to 18-months follow-up, they demonstrated significant symptom relief and functional gains while maintaining radiographic stability without slip progression. These preliminary results suggest uniportal endoscopic decompression alone may be a viable option for selected elderly patients with stable Grade II-III spondylolisthesis and warrants further investigation.