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Full-Endoscopic J-Shaped Transforaminal L5 Nerve Decompression in Bertolotti Syndrome
Chang-Il Ju1, Pius Kim1, Jong Hun Seo1
1Department of Neurosurgery, Chosun University Hospital, Gwangju, Korea.
Neurospine
|January 7, 2025
Summary
This study shows a minimally invasive endoscopic technique for L5 nerve decompression in Bertolotti syndrome, a condition causing back pain due to spinal anomalies. The J-shaped approach effectively decompresses the nerve root, offering a safe surgical alternative.
Area of Science:
- Neurosurgery
- Orthopedic Surgery
- Minimally Invasive Spine Surgery
Background:
- Bertolotti syndrome involves congenital lumbosacral transitional vertebrae, potentially causing mechanical lower back pain and L5 nerve root compression.
- Anatomical variations in Bertolotti syndrome, such as large L5 transverse processes, can complicate surgical approaches.
- A 69-year-old male with Bertolotti syndrome presented with L5 dermatome radiculopathy due to foraminal stenosis and disc herniation.
Purpose of the Study:
- To demonstrate a full-endoscopic J-shaped transforaminal technique for L5 exiting nerve decompression.
- To illustrate the surgical approach in a patient with complex anatomy due to Bertolotti syndrome.
- To highlight the minimally invasive advantages of endoscopic decompression for L5 radiculopathy.
Main Methods:
- A J-shaped transforaminal endoscopic approach was utilized, docking on the L5 transverse process.
- Endoscopic drilling in a J-configuration partially resected the transverse process and alar wing for Kambin's triangle access.
- Decompression of the L5 exiting nerve root was achieved by resecting the superior articular process (SAP) tip.
Main Results:
- Successful decompression of the L5 exiting nerve root was achieved using the full-endoscopic technique.
- The J-shaped approach facilitated safe endoscope insertion and navigation in a narrow surgical corridor.
- The procedure effectively addressed foraminal stenosis and nerve root compression in the context of Bertolotti syndrome.
Conclusions:
- Full-endoscopic spine surgery provides a safe and effective alternative to open surgery for L5 nerve decompression in Bertolotti syndrome.
- The demonstrated J-shaped technique is suitable for managing complex anatomical challenges in these patients.
- Minimally invasive endoscopic decompression offers significant advantages for treating L5 radiculopathy associated with Bertolotti syndrome.
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