Management of distal adjacent segment disease due to central subsidence of PLIF using local anesthetic transforaminal foraminotomy and lumbar discectomy

INTRODUCTION: Spinal fusion is one of the most common procedure as the treatment of lumbar pathology, this procedure not only stops the progression of spinal pathology, but also immobilizes the painful motion segment. Furthermore, it also stabilizes the spine after neural decompression. However, the increase of mechanical stress and segmental motion at adjacent segments after spinal fusion has been reported regarding to this biomechanical alteration, various pathologies might occur at the adjacent segments, including acceleration of degenerative changes (Chul et al., 2015). PRESENTATION OF CASE: Some patients are afraid to undergo second or next open surgery and prefer to choose other options such us minimally invasive surgery. Here we present management of distal adjacent segment disease using local anesthetic transforaminal foraminotomy and lumbar discectomy. We performed minimally invasive percutaneous endoscopic lumbar discectomy and foraminotomy in an awake and aware 55 years old man under local anesthesia. CONCLUSION: The procedure was successful with no complications. There was improvement in VAS and ODI score as quantitative measurement for pain relieve and functional outcome respectively, and the radiologic follow up evaluation shows a stable segment.