This report discusses the case of a 70-year-old male orthopedic surgeon with multilevel lumbar foraminal stenosis and degenerative scoliosis (Cobb angle 21°) who presented with right leg radiculopathy and foot drop. To accommodate his inability to take extended leave and his desire to avoid fusion, we performed a staged transforaminal full-endoscopic lumbar foraminotomy, consisting of one procedure per level, under local anesthesia. The procedures targeted the L5/S1, L4/5, and L3/4 levels sequentially at 1-month intervals. The patient's foot drop resolved immediately after the first surgery. At the 3-month follow-up after the final procedure, his motor deficits showed marked improvement, and his Oswestry Disability Index score decreased from 12% to 8%. He returned to his clinical duties the day after each discharge and was able to continue managing his private clinic without interruption. He resumed playing golf 2 months after the final surgery. A staged, non-fusion transforaminal full-endoscopic lumbar foraminotomy approach under local anesthesia was a safe and effective strategy for multilevel foraminal stenosis, even in the presence of deformity, providing excellent functional recovery with minimal disruption to the patient's professional life.
Kitahara et al. (Wed,) studied this question.