Minimally invasive lateral foraminotomy with partial lateral facetectomy for lumbar radiculopathy—An evaluation of facet integrity and description of the procedure

Foraminal stenosis causing nerve root compression and radiculopathy is a relatively common pathology in the lumbar spine. The treatment of choice, when surgery is indicated, is foraminal decompression at the affected level, usually through a conventional midline open foraminotomy. Minimally invasive lateral foraminotomy with partial lateral facetectomy is a potentially effective surgical alternative when such a surgery is warranted. The evaluation of the efficacy and benefits of this approach for treatment of radiculopathy; an assessment of facet integrity; and, a detailed description of the procedure are also provided. Patients with predominantly unilateral lower limb radiculopathy, who had persistent symptoms despite conservative therapy, underwent a minimally invasive lumbar lateral foraminotomy (through tubular retractors) with partial lateral facetectomy. The Oswestry disability index (ODI) and the visual analog scale (VAS) for back and leg pain were evaluated preoperatively, postoperatively, and at the latest follow-up. Facet integrity was evaluated with postoperative computed tomography (CT) scans. Between 2013 and 2014, in the 12 patients who underwent this procedure and were evaluted after a minimum follow up of 1 year, there was significant improvement in the ODI, VAS based back pain, and VAS based leg pain. A minimally invasive, lateral foraminotomy with partial lateral facetectomy is an effective alternative technique for treatment of radiculopathy due to foraminal stenosis in a carefully selected subgroup of patients. A larger study would possibly highlight the effectiveness of this procedure.