Endoscopic decompression for intraforaminal and extraforaminal nerve root compression

The records from seventeen consecutive patients treated with endoscopic posterior decompression without fusion for intaforaminal and extraforaminal nerve root compression in the lumbar spine (7 males and 10 females, mean age: 67.9 ± 10.7 years) were retrospectively reviewed. The surgical procedures consisted of lateral or translaminal decompression with or without discectomy. The following items were investigated: 1) the preoperative clinical findings; 2) the radiologic findings including MRI and computed tomography-discography; and 3) the surgical outcome as evaluated using the Japanese Orthopaedic Association scale for lower back pain (JOA score).All patients had neurological findings compatible with a radiculopathy, such as muscle weakness and sensory disturbance. MRI demonstrated the obliteration of the normal increased signal intensity fat in the intervertebral foramen. Ten patients out of 14 who underwent computed tomography-discography exhibited disc protrusion or herniation. Selective nerve root block was effective in all patients. During surgery, 12 patients were found to have a protruded disc or herniation that compressed the nerve root. Sixteen patients reported pain relief immediately after surgery.Intraforaminal and extraforaminal nerve root compression is a rare but distinct pathological condition causing severe radiculopathy. Endoscopic decompression surgery is considered to be an appropriate and less invasive surgical option.Intraforaminal and extraforaminal nerve root compression at lumbar lesions is much rarer than intraspinal canal lesions, making the diagnosis difficult [1]. The difficulties in making a correct diagnosis could unfortunately result in a failed lumbar spine surgery.Surgical intervention is considered for patients with severe radiculopathy that does not respond to conservative treatment. As interverebral foraminal nerve entrapment mostly affects the elderly, it is better to choose a minimally-invasive surgical procedure. Consequentl