• Albert E Telfeian, Adetokunbo Oyelese, Jared Fridley, Cody Doberstein, and Ziya L Gokaslan.
• Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI.
• Pain Physician. 2019 Mar 1; 22 (2): E97-E103.

BackgroundFoot drop that results from compression of the exiting L5 nerve as a result of far lateral disc herniation (FLDH) at L5-S1 poses a significant surgical challenge to the minimally-invasive spine surgeon given the narrow corridor for an extraforaminal approach because of the high iliac crest.ObjectivesHere we describe our experience with transforaminal endoscopic decompression for the treatment of foot drop secondary to FLDH at L5-S1.Study DesignRetrospective case review.SettingThis study took place in a single-center, academic hospital.MethodsA technique for the transforaminal endoscopic treatment of foot drop secondary to L5-S1 FLDH is presented in a series of 5 consecutive patients treated over a period of 3 years. Preoperative and postoperative clinical data with 1-year follow-up are presented.ResultsA consecutive series of 211 patients who underwent transforaminal endoscopic treatment for lumbar radiculopathy between 2011 and 2014 are presented. Seventy-seven patients had L5-S1 discectomies and 5 of those patients presented with foot drop and FLDH. The mean visual analog scale score for radicular pain improved from an average pain score before surgery of 7.2 to 0.8 one year after surgery, and the mean motor score for anterior tibialis strength improved from an average motor score before surgery of 2.6 to 4.8 one year after surgery.LimitationsSmall case series evaluated retrospectively with one year follow-up.ConclusionsTransforaminal endoscopic surgical access to FLDH pathology may be a unique approach to the treatment of foot drop because it allows for neural decompression of disc and foraminal pathology without requiring significant destabilizing bone removal.Key WordsEndoscopic spine surgery, minimally-invasive, transforaminal, foot drop, far lateral disc herniation.

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