Complete resolution of chronic pain, sensory impairment, and motor dysfunction following percutaneous transforaminal endoscopic decompression in a failed back surgery syndrome patient-a case report

Failed back surgery syndrome (FBSS) is an increasingly common problem that presents a clinical challenge. Though usual treatments may improve pain for some period of time, they do not provide clinically significant recovery of subjective numbness and weakness. We describe a case of a 48-year-old female with FBSS, who presented to the pain clinic with a 29-year history of low back pain, and a 7-year history of sensory and motor dysfunction of her left lower extremity, ever since a left hemi-laminectomy. At the time of presentation, she was wheelchair bound with intense pain, 4/5 strength in her left lower extremity proximally, and 3/5 strength distally. She had previously failed conservative management including medications, physical therapy, and epidural and facet injections. During percutaneous transforaminal endoscopic decompression, her transiting left L5 nerve root was found to be encased in thick scar tissue. The entirety of this scar tissue entrapping her L5 nerve was able to be released, resulting in not only complete resolution of pain but full return of sensory and motor function; in fact, the patient was able to walk out of the post anesthesia care unit without any assistive devices. Despite long-standing damage from many years of nerve entrapment, this patient's sensory and motor function was able to be restored simply by freeing her nerve of scar tissue. Thus, if nerve entrapment in scar tissue is the cause of FBSS, transforaminal endoscopic decompression may offer not only pain relief, but also return of sensory and motor function.