Transforaminal Endoscopic Lumbar Foraminotomy for Iatrogenic Foraminal Stenosis Following Vertebroplasty

다국어 초록 (Multilingual Abstract)

We present a case of iatrogenic lumbar foraminal stenosis caused by bone-cement leakage during vertebroplasty, successfully managed using transforaminal endoscopic lumbar foraminotomy (TELF). Vertebroplasty is an effective treatment for osteoporotic vertebral compression fractures (VCFs); however, complications such as bone-cement leakage can lead to vascular or neurological issues, including lumbar radiculopathy. TELF is a minimally invasive surgical option for addressing various forms of lumbar foraminal stenosis. An 82-yearold female patient presented to Gachon University Gil Medical Center with severe right inguinal pain radiating to the anterior thigh and knee. Six months prior, she had undergone vertebroplasty at the L3 level for an osteoporotic VCF at another hospital. Following the procedure, she developed radicular leg pain with a diminished knee jerk reflex, which progressively worsened despite extensive conservative treatment. Magnetic resonance imaging and computed tomography revealed right-sided L3–4 foraminal stenosis caused by bone-cement leakage from the prior vertebroplasty. TELF was performed under local anesthesia to decompress the affected area. Bone-cement fragments, along with hypertrophic bone and ligaments, were successfully removed, achieving sufficient decompression of the exiting nerve root. The patient experienced immediate postoperative pain relief. This case represents the first documented instance of endoscopic decompression for iatrogenic foraminal stenosis following vertebroplasty. TELF, performed safely under local anesthesia, demonstrates its effectiveness as a minimally invasive solution for this rare complication.

참고문헌 (Reference)

1 Jay B, "Vertebroplasty" 30 : 297-306, 2013

2 Knight MT, "Transforaminal endoscopic lumbar decompression & foraminoplasty : a 10-year prospective survivability outcome study of the treatment of foraminal stenosis and failed back surgery" 8 : 21-, 2014

3 Morgenstern R, "The learning curve in foraminal endoscopic discectomy : experience needed to achieve a 90% success rate" 1 : 100-107, 2007

4 Kelekis AD, "Radicular pain after vertebroplasty: compression or irritation of the nerve root? Initial experience with the “cooling system.”" 28 : E265-E269, 2003

5 Kelekis AD, "Radicular pain after vertebroplasty : complication and prevention" 34 : 816-, 2005

6 Gangi A, "Quality assurance guidelines for percutaneous vertebroplasty" 29 : 173-178, 2006

7 Ahn Y, "Percutaneous endoscopic lumbar foraminotomy : an advanced surgical technique and clinical outcomes" 75 : 124-133, 2014

8 Galibert P, "Note préliminaire sur le traitement des angiomes vertébraux par vertébroplastie acrylique percutanée [Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty]" 33 : 166-168, 1987

9 Knight M, "Management of isthmic spondylolisthesis with posterolateral endoscopic foraminal decompression" 28 : 573-581, 2003

10 Laredo JD, "Complications of percutaneous vertebroplasty and their prevention" 33 : 493-505, 2004

11 Hofstetter CP, "AOSpine consensus paper on nomenclature for working-channel endoscopic spinal procedures" 10 (10): 111-, 2020

12 Jasper GP, "A retrospective evaluation of the clinical success of transforaminal endoscopic discectomy with foraminotomy in geriatric patients" 16 : 225-229, 2013