Endoscopic spinal surgery in adjacent segment disease-a viable alternative to transforaminal lumbar interbody fusion:...

The authors present technical notes and describe a case of percutaneous unilateral endoscopic biportal transforaminal decompression in a patient with adjacent segment disease (ASD) following a previous transforaminal lumbar interbody fusion (TLIF).

A 69-year-old woman with a prior L4/L5 TLIF presented to the clinic with a new onset of right lower limb radiculopathy along the L3 dermatome, as well as numbness in the L2 distribution. Magnetic resonance imaging (MRI) studies revealed adjacent segment degeneration in L2/L3 and L3/L4, with disc-osteophyte complexes impinging onto the exiting L2 and L3 nerve roots, respectively. We opted for a right L2/L3 and L3/L4 unilateral endoscopic biportal transforaminal decompression. The surgery was successful, with the patient being discharged from the hospital on postoperative day 1 with minimal pain. Within 2 weeks, the patient described significant improvement in both back pain and radiculopathy, and the numbness had completely resolved. Oswestry Disability Index was used to objectively quantify outcomes and saw an improvement from 15 to 0. Notably, there were no complications.

This case highlights the successful use of unilateral biportal endoscopic transforaminal decompression to treat multi-level ASD of the lumbar spine, instead of the convention and more opted for revision TLIF. Endoscopic spinal surgery provides a promising alternative to other techniques, which can be worth its steep learning curve. This should be considered in the arsenal of spine surgeons as a minimally invasive alternative.