Diário da Espinha

Fully-Endoscopic Contralateral L5/S1 Revision Laminotomy and Inside- Out Foraminotomy in a Patient with Posterolateral Fusion Mass: Technical Note

Abstract

Jian Shen

Objectives: To present an awake, fully endoscopic surgical approach for treating radiculopathy that results from L5/ S1 foraminal stenosis in a patient who had prior interbody fusion and posterolateral fusion.

Methods: The patient underwent an awake, endoscopic decompression procedure utilizing two different sized cannula and high-speed drill system under direct visualization. Fully endoscopic revision laminotomy was done first through contralateral interlaminar approach. This was followed by endoscopic inside-out foraminotomy.

Results: The operative time was 108 minutes, estimated blood loss was negligible, and the surgery was done as outpatient. There were no intraoperative or postoperative complications. Comparison of preoperative and final clinical metrics demonstrated that Oswestry Disability Index (ODI) improved from 56 to 28. VAS-L improved from 8 to 2. The ODI and VAS-B scores at the last follow-up showed 73% and 78% improvement from the preoperative period respectively, which showed a satisfactory clinical outcome after 1-year follow-up and did not induce postoperative segmental spinal instability.

Conclusion: Fully endoscopic contralateral laminotomy and inside-out lumbar foraminotomy is a safe, effective technique for addressing lumbar foraminal stenosis, especially for patients with lumbar foraminal stenosis that are difficult for ipsilateral transforaminal approach.