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

tINTRODUCTION: 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 motionsegment. Furthermore, it also stabilizes the spine after neural decompression. However, the increase ofmechanical stress and segmental motion at adjacent segments after spinal fusion has been reportedregarding 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 tochoose other options such us minimally invasive surgery. Here we present management of distal adjacentsegment disease using local anesthetic transforaminal foraminotomy and lumbar discectomy.We performed minimally invasive percutaneous endoscopic lumbar discectomy and foraminotomy inan awake and aware 55 years old man under local anesthesia.CONCLUSION: The procedure was successful with no complications. There was improvement in VAS andODI score as quantitative measurement for pain relieve and functional outcome respectively, and theradiologic follow up evaluation shows a stable segment.