Case Report: Contralateral radiculopathy associated with facet tropism after transforaminal lumbar interbody fusion

Contralateral radiculopathy is an infrequently reported postoperative complication in patients with degenerative spondylolisthesis (DS) who receive transforaminal lumbar interbody fusion (TLIF). Herein, we report two clinical cases with this complication associated with preoperative facet tropism. Case 1 involved a patient with L4/5 DS presenting with radiating pain in the right lower extremity; new-onset left lower limb weakness and radicular pain occurred immediately after TLIF via the right side. A revision resection of the left L5 superior articular process (SAP) led to marked improvement of the patient's symptoms. Case 2 was diagnosed with L4/5 DS, and this patient developed right lower-extremity pain and weakness after left-sided primary TLIF. The contralateral radicular symptoms were significantly relieved via percutaneous endoscopic foraminotomy. This complication arises from mechanical compression of the exiting spinal nerve root by a sagittalized SAP (associated with facet tropism) after complete segmental reduction in the two cases. Surgical revision is indicated once this adverse event is identified, and percutaneous endoscopic foraminotomy may be a minimally invasive option in selected patients and in experienced hands.