Management of Root-Level Double Crush: Case Report with Technical Notes on Contralateral Interlaminar Foraminotomy with Full Endoscopic Uniportal Approach.

Abstract:

BACKGROUND:Double crush of a nerve at the root level is not common. We describe here a double crush of the right L4 nerve with foramina to far lateral disk (ventral) and extraforaminal (dorsal) compression. The double crush was managed by endoscopy with a contralateral uniportal approach from the left interlaminar space. Right lateral recess stenosis at the same level was subsequently managed with the same approach. CASE DESCRIPTION:A 79-year-old lady presented to our clinic with a low backache, right leg pain, and weakness. On her right side, the straight leg raise test was 70 degrees, great toe dorsiflexion was grade 3/5, and hypoesthesia was present in the L4 dermatome. Her preoperative visual analog scale score was 9. Magnetic resonance imaging showed right lateral recess stenosis and a double compression of L4 nerve root from the dorsal and ventral sides. A diagnosis of right lateral recess stenosis with double crush of the right L4 nerve root was made. The patient was managed with percutaneous endoscopic contralateral interlaminar foraminotomy from the left interlaminar approach. She got relief for the symptoms and her postoperative visual analog scale score was 2. Magnetic resonance imaging and computed tomography showed nerve root decompression and well-preserved facet joints. CONCLUSIONS:We conclude that the management of double crush at the nerve root level with interlaminar contralateral approach endoscopy (percutaneous endoscopic contralateral interlaminar foraminotomy) can deal with the issue effectively with facet joint preservation and other benefits of the minimally invasive spine procedure.

journal_name

World Neurosurg

journal_title

World neurosurgery

authors

Kim HS,Singh R,Adsul NM,Oh SW,Noh JH,Jang IT

doi

10.1016/j.wneu.2018.11.110

subject

Has Abstract

pub_date

2019-02-01 00:00:00

pages

505-507

eissn

1878-8750

issn

1878-8769

pii

S1878-8750(18)32660-3

journal_volume

122

pub_type

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