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

Ayaka HASHIMOTO; Fumitake TEZUKA; Kazuta YAMASHITA; Masatoshi MORIMOTO; Kosuke SUGIURA; Makoto TAKEUCHI; Yoichiro TAKATA; Toshinori SAKAI; Toru MAEDA; Koichi SAIRYO

doi:10.2176/nmccrj.cr.2020-0104

Case Reports

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

Ayaka HASHIMOTO, Fumitake TEZUKA, Kazuta YAMASHITA, Masatoshi MORIMOTO, Kosuke SUGIURA, Makoto TAKEUCHI, Yoichiro TAKATA, Toshinori SAKAI, Toru MAEDA, Koichi SAIRYO

Author information

Ayaka HASHIMOTO
Department of Orthopedics, Tokushima University, Tokushima, Tokushima, Japan
Fumitake TEZUKA
Department of Orthopedics, Tokushima University, Tokushima, Tokushima, Japan
Kazuta YAMASHITA
Department of Orthopedics, Tokushima University, Tokushima, Tokushima, Japan
Masatoshi MORIMOTO
Department of Orthopedics, Tokushima University, Tokushima, Tokushima, Japan
Kosuke SUGIURA
Department of Orthopedics, Tokushima University, Tokushima, Tokushima, Japan
Makoto TAKEUCHI
Department of Orthopedics, Tokushima University, Tokushima, Tokushima, Japan
Yoichiro TAKATA
Department of Orthopedics, Tokushima University, Tokushima, Tokushima, Japan
Toshinori SAKAI
Department of Orthopedics, Tokushima University, Tokushima, Tokushima, Japan
Toru MAEDA
Department of Orthopedics, Tokushima University, Tokushima, Tokushima, Japan
Koichi SAIRYO
Department of Orthopedics, Tokushima University, Tokushima, Tokushima, Japan

Keywords: transforaminal full-endoscopic lumbar decompression, lateral recess stenosis, ventral facetectomy, local anesthesia

JOURNAL OPEN ACCESS FULL-TEXT HTML

2021 Volume 8 Issue 1 Pages 221-227

DOI https://doi.org/10.2176/nmccrj.cr.2020-0104

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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.

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