Successful Endoscopic Surgery for L5 Radiculopathy Caused by Far-Lateral Disc Herniation at L5-S1 and L5 Isthmic Grade 2 Spondylolisthesis in a Professional Baseball Player

Abstract

Background: We report the case of a professional baseball player who had severe leg pain due to lumbar lateral disc herniation at L4-5 and isthmic spondylolisthesis at L5 (double crash syndrome). For early recovery to competitive level, we performed minimally invasive endoscopic decompression surgery without fusion. There are few reports to discuss the usefulness of minimally invasive treatment for top athletes. Methods: A 29-year-old professional baseball player who played catcher was referred to us with a complaint of right leg pain. The previous doctor diagnosed far-lateral disc herniation and Grade 2 isthmic spondylolisthesis and recommended arthrodesis at L5-S1 as treatment for both pathologies. Radiological imaging showed that the right L5 nerve root was impinged by the 2 lumbar disorders, namely, far-lateral disc herniation and a ragged edge around a pars defect. We had taken into account the patient's occupation and his wish to avoid a lengthy sick leave, and we had performed endoscopic decompression surgery during the offseason. The far-lateral disc herniation at L5-S1 was removed under local anesthesia by percutaneous endoscopic discectomy, after which the ragged edge at the pars defect was removed under general anesthesia using a microendoscopic discectomy system. Given that the patient did not have any low back pain, arthrodesis was not considered. Results: The leg pain resolved after surgery. The following year (2015), the patient resumed playing baseball from the beginning of the season and played in 41 games. In the 2016 season, he played in 71 games without any symptoms. No further slippage was observed at radiological follow up 1 year after the surgery. Conclusions: Minimally invasive endoscopic surgery is an option for radiculopathy in very active patients who need an early return to their previous level of physical activity.

Implementation of Percutaneous Transforaminal Endoscopic Discectomy in Competitive Elite Athletes With Lumbar Disc Herniation: Original Study and Review of the Literature

“…This result is consistent with the outcomes of the other published related studies. 1,20,27,28 However, patients in our study required a shorter interval to completely return to their sports when compared with patients from the other studies. This peculiar outcome may be attributed to the minimally invasive character of PTED, which warrants minimal traumatization, minor intraoperative hemorrhage, and preservation of dorsal musculature as well as related osseous and ligamentous structures.…”

“…Minimally invasive endoscopic surgery was thus concluded to represent a satisfactory alternative for radiculopathy in such patients. 28 To our best knowledge, Nakamae et al 20 were the only authors to publish an original study regarding PTED for surgical treatment of LDH in athletes. Twenty-one competitive athletes in different sports and levels of sporting activity were retrospectively studied for a mean 28.1 months.…”

An Elite Triathlete with High-grade Isthmic Spondylolisthesis Treated by Lumbar Decompression Surgery without Fusion

“…Like the patient described by Yamashita et al, 10) our patient was considered for minimally invasive endoscopic surgery. However, the major difference between these cases is that our patient had upside-down foraminal stenosis and the degree of slippage was high grade.…”

“…The indications for this technique were radiculopathy without low back pain, no spinal instability on dynamic radiographs, and age older than 40 years. In a recent report, Yamashita et al 10) described successful endoscopic surgery in a professional baseball player with grade 2 isthmic spondylolisthesis and considered that minimally invasive endoscopic surgery is an option for radiculopathy in very active patients who need an early return to their previous level of physical activity, such as professional sports players. The patient did not have upside-down stenosis and only a ragged edge needed to be removed, so endoscopic surgery was possible.…”

A comparative study of L4-L5-S1 and L5-S1 vertebral fusion in high-grade L5-S1 spondylolisthesis

“…The Cotrel-Dubousset system was developed in the 1980s, and the benefits of using pedicular screws have been reported by Cotrel, Roy Camille, and Steffee since the mid-1980s. [ 15 ] Although many studies have been conducted on the advantages and disadvantages of vertebral fusion with instrumentation compared to the traditional method (without instrumentation), the physical and biomechanical properties of the spine in improving spondylolisthesis have received less attention and such expression. It has been found that in vertebral fusion using pedicular screws, fewer segments of the spine are involved and in terms of stability, it creates more strength in rotation and translation positions.…”