Single-Stage Full-Endoscopic Pars Crisscross Decompression and Discectomy for Combined Foraminal Stenosis and Lateral Disc Herniation: A Report of 2 Cases

BACKGROUND: Full-endoscopic pars crisscross decompression has recently been introduced as a local-anesthesia procedure for foraminal stenosis associated with stable L5 isthmic spondylolisthesis. Although transforaminal endoscopic foraminoplasty combined with discectomy has been described in patients with spondylolisthesis, the pars crisscross technique may provide a distinct working corridor for simultaneous treatment of bony foraminal stenosis and concomitant lateral disc pathology. We present 2 cases treated with single-stage pars crisscross decompression and discectomy under local anesthesia. CASE PRESENTATION: Two patients, a 51-year-old woman and a 60-year-old man, presented with unilateral L5 radiculopathy refractory to conservative treatment. Imaging demonstrated L5 isthmic spondylolisthesis, ipsilateral L5/S1 foraminal stenosis, and concomitant lateral disc herniation without significant segmental instability. CASE MANAGEMENT: Both patients underwent single-stage full-endoscopic pars crisscross decompression and endoscopic discectomy under local anesthesia. Adequate decompression of the exiting L5 nerve root was achieved by sequential resection of the bony components of the pars defect, followed by removal of the herniated disc. Leg pain improved immediately after surgery in both patients. Postoperative imaging confirmed adequate foraminal decompression. No perioperative complications occurred. At 18 months in case 1 and 12 months in case 2, neither patient demonstrated recurrence of radicular symptoms, progression of low back pain, or radiographic evidence of segmental instability. CONCLUSION: Transforaminal full-endoscopic spine surgery using the pars crisscross technique provided effective decompression of both bony and discal pathology in carefully selected patients with stable L5 isthmic spondylolisthesis and concomitant lateral disc herniation. Larger studies with longer follow-up are required before its role relative to fusion surgery can be established. CLINICAL RELEVANCE: The pars crisscross technique may offer a minimally invasive, motion-preserving surgical option for selected patients with stable isthmic spondylolisthesis and concomitant foraminal stenosis and lateral disc herniation, potentially avoiding fusion surgery while allowing treatment under local anesthesia.