Arthroscopic-assisted uniportal spinal surgery for recurrent lumbar schwannoma: a hybrid approach case report

To describe the management of recurrent lumbar schwannomas located within the intertransverse space and psoas compartment using a single-incision hybrid approach that combines open surgery with Arthroscopic-Assisted Uniportal Spinal Surgery (AUSS).

A 78-year-old woman presented with a 1-month history of low back pain and left-sided radiculopathy. Seventeen years earlier, she had undergone lumbar schwannoma removal. MRI revealed multiple recurrent tumors along the left L4 nerve root, including lesions in the paraspinal and deep intertransverse-psoas compartments. A hybrid surgical strategy was employed: superficial tumors were resected via an open approach, and deeper lesions were removed endoscopically using AUSS through the same incision.

All tumors were successfully excised en bloc. AUSS provided high-definition visualization that facilitated circumferential dissection of a tumor densely adherent to the L4 nerve root. The patient experienced rapid relief of symptoms postoperatively, with complete resolution of radicular pain. Follow-up CT/MRI confirmed full tumor resection and adequate neural decompression. Histopathology confirmed multiple schwannomas.

A combined open-AUSS approach through a single incision offers a feasible and safe option for treating recurrent lumbar schwannomas extending across multiple anatomical compartments. This hybrid strategy minimizes tissue disruption and may represent an effective alternative for managing complex recurrent paraspinal tumors.