Planned Four-stage Transforaminal Full-endoscopic Lumbar Decompression under Local Anesthesia in a Patient with Severe Comorbidity

Abstract

A 74-year-old man presented with symptoms of intermittent claudication. A diagnosis of lumbar spinal canal stenosis (LSS) at L3/4 and L4/5 was made based on the clinical and radiological findings. Bilateral lateral recess stenosis was detected at both these levels on magnetic resonance imaging (MRI) and on computed tomography (CT) scans obtained after myelography. Four nerve roots were impinged bilaterally at L4 and L5. The initial plan was to perform conventional laminectomy at L3/4 and L4/5 under general anesthesia. However, the neurologists pointed out that the patient had comorbidities of parkinsonism and severe carotid artery stenosis, meaning that an increase or decrease in blood pressure during general anesthesia could cause a stroke. Therefore, we changed the surgical plan to four-stage full-endoscopic ventral facetectomy at L3/4 and L4/5 bilaterally under local anesthesia. There were no surgery-related complications after any of the four operations. The patient's symptoms improved after the final operation and the modified MacNab criteria indicated a good clinical outcome. Full-endoscopic lumbar decompression surgery under local anesthesia may be effective in elderly patients who are in poor general health.

Advantages of Full-endoscopic Trans-Kambin's Triangle Lumbar Interbody Fusion for Degenerative Spondylolisthesis: Illustrative Cases

“…Full-endoscopic discectomy, which was initially developed by Yeung and Tsou for lumbar disc herniation, 6) is a minimally invasive procedure that is now used to treat foraminal stenosis and lateral recess stenosis. 1,[7][8][9] Lumbar interbody fixation can now be performed by full-endoscopic discectomy using the procedure named KLIF by Sairyo et al 2) Various types of LIF have been reported, including ALIF, LLIF, TLIF, and PLIF. There has been a recent report de-scribing the use of LLIF to treat adult spinal deformity because of its indirect decompressive effect, less surgical invasiveness and blood loss, and strong corrective force.…”

“…Full-endoscopic discectomy, which was initially developed by Yeung and Tsou for lumbar disc herniation, 6 ) is a minimally invasive procedure that is now used to treat foraminal stenosis and lateral recess stenosis. 1 , 7 - 9 ) Lumbar interbody fixation can now be performed by full-endoscopic discectomy using the procedure named KLIF by Sairyo et al 2 )…”

Lumbar Endoscopic Unilateral Laminotomy With Bilateral Decompression Surgery in Severe Lumbar Stenosis Under Electrophysiological Monitoring-Focused on Full-Visualized Trephine/Osteotome

“…Due to the wide range of treatable lumbar stenosis and the reported favorable clinical outcomes, the endoscopic posterior approach has attracted more and more attention. [17][18][19][20][21][22] As we all know, the outside-in technique was most accepted in the LE-ULBD surgery, 23 whose procedure involves removal of bony structure including the lamina, articular facet joint first, then the entire LF en bloc or piecemeal to expose the dura and nerve root. However, the outside-in technique has disadvantages including uncertain removal border, dura tear and nerve injury.…”

Full-Endoscopic Foraminal Decompression for Foraminal Stenosis Following Osteoporotic Vertebral Fracture in an Elderly Woman Under Local Anesthesia:A Case Report

“…However, transforaminal FESS can be conducted with a skin incision that is only 7-8 mm (10)(11)(12)(13)(14). FESS is the best option for elderly patients with poor general condition and foraminal stenosis following OVF because it is minimally invasive and can be performed under local anesthesia (23,24). However, information on this surgical technique in the literature remains sparse (17,18,25).…”