title: Foraminoplastic transforaminal percutaneous endoscopic discectomy at the lumbosacral junction under local anesthesia in an elite rugby player.
abstract: Percutaneous endoscopic discectomy (PED) is the least invasive disc surgery available at present. The procedure can be performed under local anesthesia and requires only an 8 mm skin incision. Furthermore, damage to the back muscle is considered minimal, which is particularly important for disc surgery in athletes. However, employing the transforaminal (TF) PED approach at the lumbosacral junction can be challenging due to anatomical constraints imposed by the iliac crest. In such cases, foraminoplasty is required in addition to the standard TF procedure. A 28-year-old man who was a very active rugby player visited us complaining of lower back and left leg pain. His visual analog scale (VAS) score for pain was 8/10 and 3/10, respectively. MRI revealed a herniated nucleus pulposus at L5-S level. TF-PED was planned; however, the anatomy of the iliac crest was later found to prevent access to the herniated mass. Foraminoplasty was therefore performed to enlarge the foramen, thereby allowing a cannula to be passed through the foramen into the canal without causing exiting nerve injury. The herniated mass was then successfully removed via the TF-PED procedure. Pain resolved after surgery, and his VAS score decreased to 0/10 for both back and leg pain. The patient returned to full rugby activity 8 weeks after surgery. In conclusion, even with an intracanalicular herniated mass at the lumbosacral junction, a TF-PED procedure is possible if additional foraminoplasty is adequately performed to enlarge the foramen.
authors.affiliation: Department of Orthopedics, Tokushima University.
authors.forename: Mitsunobu
authors.initials: M
authors.lastname: Abe
authors.forename: Yoichiro
authors.initials: Y
authors.lastname: Takata
authors.forename: Kosaku
authors.initials: K
authors.lastname: Higashino
authors.forename: Toshinori
authors.initials: T
authors.lastname: Sakai
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Matsuura
authors.forename: Naoto
authors.initials: N
authors.lastname: Suzue
authors.forename: Daisuke
authors.initials: D
authors.lastname: Hamada
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Goto
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Nishisho
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Goda
authors.forename: Takahiko
authors.initials: T
authors.lastname: Tsutsui
authors.forename: Ichiro
authors.initials: I
authors.lastname: Tonogai
authors.forename: Ryo
authors.initials: R
authors.lastname: Miyagi
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Morimoto
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Mineta
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Kimura
authors.forename: Akihiro
authors.initials: A
authors.lastname: Nitta
authors.forename: Shingo
authors.initials: S
authors.lastname: Hama
authors.forename: Tadahiro
authors.initials: T
authors.lastname: Higuchi
authors.forename: Subash
authors.initials: S
authors.lastname: C Jha
authors.forename: Rui
authors.initials: R
authors.lastname: Takahashi
authors.forename: Shoji
authors.initials: S
authors.lastname: Fukuta
authors.forename: Koichi
authors.initials: K
authors.lastname: Sairyo
mesh_terms: D000328:Adult; D000772:Anesthesia, Local; D017587:Diskectomy, Percutaneous / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D005538:Football; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D012447:Sacrum