Full-endoscopic Decompression of Foraminal Stenosis Caused by Facet Hypertrophy Contralateral to the Dominant Hand in a Baseball Pitcher: A Case Report

Abstract

Back pain and lower extremity pain have various causes and occasionally occur simultaneously, creating diagnostic difficulties. In addition, athletes require special consideration in terms of treatment. Here, we report a case of foraminal stenosis as a result of lumbar disc prolapse combined with facet hypertrophy contralateral to the dominant hand in a baseball pitcher that was successfully treated by minimally invasive full-endoscopic surgery. A 31-year-old left-handed male baseball pitcher presented with complaints of low back pain and right buttock pain while pitching. A diagnosis of foraminal stenosis caused by a disc bulge combined with facet hypertrophy contralateral to the dominant hand was made on the basis of physical and radiological findings. His symptoms improved immediately after transforaminal full-endoscopic lumbar discectomy and foraminoplasty under local anesthesia. He returned to play 3 months after surgery. Foraminal stenosis due to facet hypertrophy may occur in the side contralateral to the throwing arm in pitchers. Minimally invasive decompression using a full-endoscopic procedure is required for high-level athletes at this position.

Keywords: baseball player; facet hypertrophy; foraminal stenosis; full-endoscopic surgery; low back pain.

Fig. 1

(A) Standing whole spine radiograph showing mild right-sided scoliosis. CT images showing (B) bony stenosis of the intervertebral foramen and (C) right facet hypertrophy when compared with the left side. (D) Right oblique view on a reconstructed three-dimensional CT image shows a hypertrophic superior articular process (indicated by the arrow and circle) in the sacrum. CT: computed tomography.

Fig. 2

(A) On sagittal MRI, there is no evidence of the nerve root compression. (B) demonstrates the axial view of MRI through the L5 caudal endplate. On the right side, a yellow circle indicates the right side intervertebral foramen. As comparing to the left side, the right foramen is very narrow. The intervertebral disc at L5–S1 shows slight bulging to the right foramen. (C) Double yellow allows indicate the bilateral L5 nerve roots. While the left L5 nerve root is straight, the right L5 nerve is curved. It may suggest the disc material pushes the right L5 nerve root. MRI: magnetic resonance imaging.

Fig. 3

L5 radiculography reveals high nerve root take-off angles from the intervertebral foramen at L5–S1 on the right side.

Fig. 4

(A) Postoperative CT images showing foraminal enlargement. The arrow and circle indicate adequate resection of the superior articular process of the sacrum on the right side. (B) On sagittal MRI, there is postoperative change and enlargement of foramen. Axial view of MRI through the L5 caudal endplate demonstrates that the right side intervertebral foramen indicated by yellow circle was enlarged, and the right L5 nerve can be confirmed. Double yellow indicates the bilateral L5 nerve roots. The right L5 nerve is straight as with the left L5 nerve root. CT: computed tomography, MRI: magnetic resonance imaging.