Role of endoscopic sequestrectomy in the treatment of therapy-resistant radiculopathy in patients with extreme obesity: technical note and case report

Background: Surgical treatment of therapy-resistant radiculopathy associated with lumbar herniated discs in patients with extreme obesity is a challenge for neurosurgeons. In addition to technical problems in surgery due to the abundant subcutaneous adipose tissue and perioperative risks, there are significant anesthetic risks when anesthesia is performed with a patient in the prone position. A surgical procedure should preferably be minimally traumatic and quick with minimal risks of complications. Large studies show good results with minimally invasive techniques, namely microsurgical and endoscopic ones. However, in the case of surgeries in patients with extreme obesity, an endoscopic approach seems to be preferable because the spinal canal is quickly reached through a small skin incision using this approach. Case Description: We describe in detail the successful surgical treatment of a 48-year-old patient with extreme obesity (body mass index 54.3 kg/m²) and therapy-resistant immobilizing radiculopathy at the L4 level on the left by minimally invasive endoscopic sequestrectomy. Following the surgery, the patient was rapidly mobilized and discharged on the 4th postoperative day. No complications were reported in the early and late postoperative periods. Conclusions: The endoscopic approach can be successfully used for the treatment of therapy-resistant radiculopathy in patients with extreme obesity and can be considered as the main technique of surgical treatment, being both quick and minimally traumatic.