PT  - JOURNAL ARTICLE
AU  - Yamashita, Kazuta
AU  - Tezuka, Fumitake
AU  - Manabe, Hiroaki
AU  - Morimoto, Masatoshi
AU  - Hayashi, Fumio
AU  - Takata, Yoichiro
AU  - Sakai, Toshinori
AU  - Yonezu, Hiroshi
AU  - Higashino, Kosaku
AU  - Chikawa, Takashi
AU  - Nagamachi, Akihiro
AU  - Sairyo, Koichi
TI  - Successful Endoscopic Surgery for L5 Radiculopathy Caused by Far-Lateral Disc Herniation at L5-S1 and L5 Isthmic Grade 2 Spondylolisthesis in a Professional Baseball Player
AID  - 10.14444/5077
DP  - 2018 Sep 01
TA  - International Journal of Spine Surgery
PG  - 5077
4099  - https://www.ijssurgery.com/content/early/2018/09/28/5077.short
4100  - https://www.ijssurgery.com/content/early/2018/09/28/5077.full
AB  - Background We report the case of a professional baseball player who had severe leg pain due to lumbar lateral disc herniation at L4-5 and isthmic spondylolisthesis at L5 (double crash syndrome). For early recovery to competitive level, we performed minimally invasive endoscopic decompression surgery without fusion. There are few reports to discuss the usefulness of minimally invasive treatment for top athletes. Methods A 29-year-old professional baseball player who played catcher was referred to us with a complaint of right leg pain. The previous doctor diagnosed far-lateral disc herniation and Grade 2 isthmic spondylolisthesis and recommended arthrodesis at L5-S1 as treatment for both pathologies. Radiological imaging showed that the right L5 nerve root was impinged by the 2 lumbar disorders, namely, far-lateral disc herniation and a ragged edge around a pars defect. We had taken into account the patient's occupation and his wish to avoid a lengthy sick leave, and we had performed endoscopic decompression surgery during the offseason. The far-lateral disc herniation at L5-S1 was removed under local anesthesia by percutaneous endoscopic discectomy, after which the ragged edge at the pars defect was removed under general anesthesia using a microendoscopic discectomy system. Given that the patient did not have any low back pain, arthrodesis was not considered.Results The leg pain resolved after surgery. The following year (2015), the patient resumed playing baseball from the beginning of the season and played in 41 games. In the 2016 season, he played in 71 games without any symptoms. No further slippage was observed at radiological follow up 1 year after the surgery.Conclusions Minimally invasive endoscopic surgery is an option for radiculopathy in very active patients who need an early return to their previous level of physical activity.