L5 radiculopathy caused by L5 nerve root entrapment by an L5-S1 anterior osteophyte

BACKGROUND: L5 radiculopathy is a common problem that has several causes. Entrapment of the L5 nerve root by anterior osteophytes at the L5-S1 junction is rarely reported. Posterior decompression of the L5 nerve root is commonly performed, but anterior decompression of the L5 nerve root is not a frequently performed procedure. The purpose of this case report is to describe an uncommon case of L5 radiculopathy caused by the entrapment of the L5 nerve root by an anterior osteophyte. METHODS: We report the case of a 79-year-old man with a right lower extremity L5 radiculopathy causing excruciating pain, worsening with transitioning between seated and standing positions. Radiologic evaluation showed a large osteophyte coming off of the right anterolateral border of L5-S1. The osteophyte was excised through a right-sided anterior retroperitoneal approach. An anterior interbody fusion was performed at L5-S1. RESULTS: Postoperatively, the patient's pain was completely resolved. Six months after surgery, he remained symptom free. CONCLUSIONS: Osteophytes at the L5-S1 junction can entrap the L5 nerve root. If nonoperative treatment fails, the osteophyte can be excised and the nerve can be safely decompressed through an anterior retroperitoneal approach.