Transforaminal endoscopic foraminotomy for iatrogenic contralateral foraminal stenosis caused by overcorrection of spondylolisthesis: a case report

Background Iatrogenic contralateral foraminal stenosis is a not uncommon complication following unilateral transforaminal lumbar interbody fusion (TLIF). Notably, secondary contralateral foraminal stenosis induced by overcorrection of spondylolisthesis during TLIF is not a rare clinical event but remains underrecognized. This case report presents a successful minimally invasive management of this complication via transforaminal endoscopic lumbar foraminotomy, carrying important cautionary significance for clinical practice. This study aims to alert surgeons to avoid this iatrogenic complication and provide a specific procedural approach for its management when it occurs. Case presentation A 64-year-old Han Chinese male patient, diagnosed with L4-5 lumbar spondylolisthesis and L5-S1 lumbar disk herniation, experienced contralateral radiculopathy affecting the right L4 nerve root subsequent to a unilateral TLIF procedure. A computed tomography (CT) scan revealed significant right L4-5 foraminal stenosis caused by excessive correction of spondylolisthesis. Then he received transforaminal endoscopic lumbar foraminotomy, which led to significant pain reduction and functional enhancement. Conclusion This case illustrates a scenario of endoscopic decompression addressing iatrogenic contralateral foraminal stenosis, resulting from overcorrection of spondylolisthesis. It effectively showcases the efficacy of this minimally invasive approach in managing such complications. Additionally, the occurrence of iatrogenic posterior spondylolisthesis should be meticulously avoided during the TLIF procedure.