Endoscopic ALIF Decompression

Albert Telfeian, MD, PhD

Brown Neurosurgery


Patient history / exam

Patient is a 48-year-old male with prior L5-S1 ALIF 2016, and L3-4 LLIF 2018, who presents for evaluation of low back and leg pain. He describes several months of low back pain radiating down his right leg – from anterior thigh down to the top of his foot. The pain is more of a tingling discomfort vs a sharp pain. He says it is worse with standing, walking for long periods of time (> 5 min). His leg pain is more bothersome than his low back pain (chronic).

Diagnosis

Imaging revealed compression of the right L5 nerve in the right L5-S1 foramen by a bony ridge. (Figure 1)

Treatment

The patient underwent a right lumbar 5-sacral 1 awake, transforaminal endoscopic decompression of the right L5-S1 ventral bony ridge with an endoscopic drill. (Figure 2) The surgery was performed with the patient awake with local anesthetic and intravenous sedation.

Outcome

Patient was able to communicate intra-operatively that his right leg and foot pain had immediately resolved. Clinical benefit maintained at 2-year follow up and 2-year follow-up MRI demonstrates foraminal decompression (Figure 3).

Discussion

Transforaminal endoscopic treatment for foraminal compression after ALIF is a truly minimally invasive treatment option that is performed with the patient awake and, in an outpatient, setting.

Figure 1

Figure 2

Figure 3