Full-Endoscopic Discectomy in an Adult Postoperative Spinal Dysraphism Patient: A Case Report

A 52-year-old male patient presented with right lumbar pain and was diagnosed with a herniated disc using MRI. Based on his symptoms, a full-endoscopic discectomy via transforaminal approach (FED-TF) was planned. However, we focused on the possibility of an abnormal spinal anomaly due to a history of prior surgery for spina bifida during childhood that was identified through an interview. Although the FED-TF approach is sometimes used in the upper lumbar spine, this approach may damage the existing nerve in the Kambin's triangle due to an abnormal nerve root course; therefore, we changed the surgical approach to a full-endoscopic discectomy via interlaminar approach (FED-IL) and successfully completed the surgery. Despite the rarity of spinal dysraphism in children with an estimated incidence of 0.05-0.25 per 1000 live births, the probability of these patients undergoing spinal surgery in adulthood is unknown, and the total percentage of those requiring surgery is likely to be small. However, the possibility of abnormal nerve course should be considered when planning surgery for these patients. Therefore, it is important to pay attention to the route of the root and to obtain a preoperative coronal MRI in patients who have undergone spinal surgery during their childhood. Careful interviews and preoperative imaging are of critical importance for the safety and efficacy of spine surgery.