Full-endoscopic Decompression of Foraminal Stenosis Caused by Facet Hypertrophy Contralateral to the Dominant Hand in a Baseball Pitcher: A Case Report

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Abstract

Back pain and lower extremity pain have various causes and occasionally occur simultaneously, creating diagnostic difficulties. In addition, athletes require special consideration in terms of treatment. Here, we report a case of foraminal stenosis as a result of lumbar disc prolapse combined with facet hypertrophy contralateral to the dominant hand in a baseball pitcher that was successfully treated by minimally invasive full-endoscopic surgery. A 31-year-old left-handed male baseball pitcher presented with complaints of low back pain and right buttock pain while pitching. A diagnosis of foraminal stenosis caused by a disc bulge combined with facet hypertrophy contralateral to the dominant hand was made on the basis of physical and radiological findings. His symptoms improved immediately after transforaminal full-endoscopic lumbar discectomy and foraminoplasty under local anesthesia. He returned to play 3 months after surgery. Foraminal stenosis due to facet hypertrophy may occur in the side contralateral to the throwing arm in pitchers. Minimally invasive decompression using a full-endoscopic procedure is required for high-level athletes at this position.

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Most cited references 19

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Posterolateral endoscopic excision for lumbar disc herniation: Surgical technique, outcome, and complications in 307 consecutive cases.

Christopher A Yeung, Paul Tsou (2002)

A retrospective review involving 307 consecutive cases of lumbar disc herniation managed by posterolateral endoscopic discectomy was conducted. To describe a contemporary posterolateral endoscopic decompression technique for radiculopathy secondary to lumbar disc herniation; to evaluate the efficacy of the technique as it is applied to lumbar disc herniation including primary herniation, reherniation, intracanal herniation, and extracanal herniation; and to report outcome and complications. The concept of percutaneous posterolateral nucleotomy was introduced in 1973. The development of the related equipment and technique had witnessed a slow and lengthy evolution. A retrospective assessment of 307 patients was performed at least 1 year after their index operation. The outcome was graded according to a modified MacNab method. A patient-based outcome questionnaire also was incorporated into the study. The surgeon-performed assessment showed satisfactory results in 89.3% of the cases. The rate of response to the questionnaire was 91%. The responses indicated that 90.7% of the respondents were satisfied with their surgical outcome and would undergo the same endoscopic procedure again if faced with a similar herniation in the future. The poor outcome occurred in 10.7% of the primary group and 9.7% of the questionnaire group. The combined major and minor complication rate was 3.5%. The surgical outcome of posterolateral endoscopic discectomy for lumbar disc herniation is comparable with that for the traditional open transcanal microdiscectomy. Intracanal and extracanal herniations, reherniations, and incidental lateral recess stenosis can be addressed by the same approach.

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State-of-the-art transforaminal percutaneous endoscopic lumbar surgery under local anesthesia: Discectomy, foraminoplasty, and ventral facetectomy

Koichi Sairyo, Takashi Chikawa, Akihiro Nagamachi (2018)

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Low-back pain in athletes.

Jeremy Bono (2004)

While most occurrences of low-back pain in athletes are self-limited sprains or strains, persistent, chronic, or recurrent symptoms are frequently associated with degenerative lumbar disc disease or spondylolytic stress lesions. The prevalence of radiographic evidence of disc degeneration is higher in athletes than it is in nonathletes; however, it remains unclear whether this correlates with a higher rate of back pain. Although there is little peer-reviewed clinical information on the subject, it is possible that chronic pain from degenerative disc disease that is recalcitrant after intensive and continuous nonoperative care can be successfully treated with interbody fusion in selected athletes. In general, the prevalence of spondylolysis is not higher in athletes than it is in nonathletes, although participation in sports involving repetitive hyperextension maneuvers, such as gymnastics, wrestling, and diving, appears to be associated with disproportionately higher rates of spondylolysis. Nonoperative treatment of spondylolysis results in successful pain relief in approximately 80% of athletes, independent of radiographic evidence of defect healing. In recalcitrant cases, direct surgical repair of the pars interarticularis with internal fixation and bone-grafting can yield high rates of pain relief in competitive athletes and allow a high percentage to return to play. Sacral stress fractures occur almost exclusively in individuals participating in high-level running sports, such as track or marathon. Treatment includes a brief period of limited weight-bearing followed by progressive mobilization, physical therapy, and return to sports in one to two months, when the pain has resolved.

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Author and article information

Journal

Journal ID (nlm-ta): NMC Case Rep J

Journal ID (iso-abbrev): NMC Case Rep J

Journal ID (publisher-id): NMCCRJ

Title: NMC Case Report Journal

Publisher: The Japan Neurosurgical Society

ISSN (Electronic): 2188-4226

Publication date Collection: September 2020

Publication date (Electronic): 21 September 2020

Volume: 7

Issue: 4

Pages: 173-177

Affiliations

[1 ] Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Tokushima, Japan

Author notes

Corresponding author: Hiroaki Manabe, MD, Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-cho, Tokushima, Tokushima 770-8503, Japan. s52726362@ 123456yahoo.co.jp

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Publisher ID: nmccrj-7-173

DOI: 10.2176/nmccrj.cr.2019-0075

PMC ID: 7538464

PubMed ID: 33062564

SO-VID: 59fbddb4-c26b-410b-9bcc-ecdb1d66c03b

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/4.0/

Full-endoscopic Decompression of Foraminal Stenosis Caused by Facet Hypertrophy Contralateral to the Dominant Hand in a Baseball Pitcher: A Case Report

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Most cited references 19

Posterolateral endoscopic excision for lumbar disc herniation: Surgical technique, outcome, and complications in 307 consecutive cases.

State-of-the-art transforaminal percutaneous endoscopic lumbar surgery under local anesthesia: Discectomy, foraminoplasty, and ventral facetectomy

Low-back pain in athletes.

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