Elsevier

World Neurosurgery

Volume 116, August 2018, Pages 136-139
World Neurosurgery

Technical Note
Transforaminal Endoscopic Decompression for Foot Drop 12 Years After Lumbar Total Disk Replacement

https://doi.org/10.1016/j.wneu.2018.05.089Get rights and content

Highlights

  • Lumbar radiculopathy in the setting of TDR is a complex problem.

  • Foot drop is a possible delayed complication after L5-S1 TDR.

  • Endoscopic surgical decompression is possible after TDR.

Lumbar total disk replacement is considered for the treatment of lumbar degenerative disk disease with the hope that by preserving motion, the long-term fusion complication of adjacent segment disease can be avoided. The complications of lumbar total disk replacement can be divided into approach-related and long-term complications. Little has been described about the complications and treatment for complications >10 years after the device has been implanted. Here we describe a transforaminal endoscopic diskectomy procedure for a patient presenting with foot drop 12 years after a L5-S1 total disk replacement.

Introduction

Lumbar total disk replacement (LTDR) is a motion-preserving technology considered in the surgical treatment of lumbar degenerative disk disease in the hope of avoiding, most significantly, the fusion-related complication of adjacent-segment disease. LTDR complications can be grouped into early and late or approach or wear related. The first Charite LTDR was placed in 1984, first ProDisc-L was placed in 1990, and the ProDisc-II was launched in 1999; since then, many different designs have been available from different companies around the world.

Transforaminal endoscopic lumbar diskectomy is a minimally invasive spinal surgery procedure that was introduced by Kambin and Gellman in 1973.1 Advances in endoscopic visualization and instrumentation have led to an increased popularity of the technique; however, endoscopic spine surgery presents challenges to surgeons considering adopting the technique in terms of novel targeting and visualization. Here we describe a novel technique for addressing symptomatic nerve root compression in the setting of an LTDR by way of a transforaminal approach that allows for successful simple decompression surgery without requiring a destabilizing facet removal that could result in failure of the motion preservation device.

Section snippets

Case History

The patient is a 68-year-old male who presented with a complaint of 1 month of a right foot drop and some right lower extremity pain in an L5 distribution. He had a lumbar 3–4 diskectomy 14 years prior and an instrumented lumbar fusion at L3-4 and a L5-S1 total disk replacement (TDR) 12 years prior. He had tried physical therapy for several weeks without improvement. On examination he had 3/5 strength in his right foot and great toe dorsiflexion. He could not heel walk. He had right L5 numbness

Discussion

The goal of disk replacement surgery is to treat the problem of degenerative disk disease with technology that preserves motion and does not have the fusion-related side effect of adjacent segment disease. After fusion surgery, the clock starts on adjacent segment wear, but the treated segment is “fixed.” Here we are faced with the reality of a long-term complication inherent in TDR: the possibility of subsequent long-term wear at the treated level resulting in nerve compression (i.e., same

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