Diagnosis
L4-5 post-laminectomy recurrent and residual stenosis with degenerative spondylolisthesis and segmental instability. L5-S1 bilateral foraminal stenosis with severe facet arthropathy and facet disruption. Right-dominant bilateral L5 and S1 radiculopathy with motor weakness and gait disturbance.
Procedure and level
UBE-TLIF (Unilateral Biportal Endoscopic Transforaminal Lumbar Interbody Fusion) at L4-5 and L5-S1, each with bilateral decompression and foraminal decompression. L4-5 and L5-S1.
Surgical levels and level count
- Treated levels
- 2 levels
- L4-L5 · L5-S1
- Decompression
- 2 levels
- L4-L5 · L5-S1
- New fusion
- 2 levels
- L4-L5 · L5-S1
Two fusion segments, each with decompression. Bilateral work and multiple procedures at the same segment do not create additional levels.
One level means one treated motion segment, such as L4-L5. Decompression and fusion can overlap; their counts are not added. Counts follow the source description and have not been re-audited against private charts.
Clinical presentation
A 71-year-old de-identified male presented with right-dominant bilateral L5 and S1 radiculopathy, motor weakness, and gait disturbance. The symptoms developed in the context of previous lumbar laminectomy and were concordant with imaging findings of recurrent stenosis at L4-5 and bilateral foraminal stenosis at L5-S1.
Neurologic findings
Preoperative neurologic examination documented right-dominant bilateral radicular symptoms in L5 and S1 distributions, motor weakness, and gait disturbance concordant with the stenotic levels. Specific motor grades and sensory findings are not reported in this summary.
Prior nonoperative treatment
Symptoms persisted despite conservative management. Surgical treatment was considered because the clinical findings remained significant and were concordant with multilevel imaging findings in the setting of prior laminectomy.
Imaging and clinical concordance
Preoperative radiographs demonstrated spondylolisthesis and segmental instability at L4-5 and severe facet arthropathy with facet disruption at L5-S1. Preoperative MRI demonstrated recurrent and residual stenosis at L4-5 and bilateral foraminal stenosis at L5-S1, concordant with the patient's right-dominant bilateral radicular symptoms and neurologic findings.
Reasoning recorded for the procedure
UBE-TLIF was selected at both L4-5 and L5-S1 because each level required decompression combined with interbody stabilization. At L4-5, the post-laminectomy recurrent stenosis with spondylolisthesis and segmental instability indicated the need for fusion in addition to decompression. At L5-S1, bilateral foraminal stenosis with severe facet arthropathy and facet disruption required foraminal decompression and stabilization. Bilateral decompression was performed at each level to address the bilateral symptom pattern.
Operative considerations
UBE-TLIF was performed at L4-5 and L5-S1. At each level, bilateral decompression and foraminal decompression were performed through the biportal endoscopic approach, followed by disc space preparation, interbody cage placement, and posterior fixation. In the post-laminectomy field at L4-5, careful dissection was required to identify and protect neural structures in the setting of prior surgical changes. At L5-S1, foraminal decompression addressed the bilateral foraminal stenosis and facet disruption pattern.
Postoperative course
Not reported in the available educational summary.
Postoperative imaging
Postoperative radiographs and MRI demonstrated interbody fusion and posterior stabilization at L4-5 and L5-S1 with decompression at the operative levels. Imaging is presented only after full de-identification.
Educational point
This case illustrates three teaching points. First, post-laminectomy recurrent stenosis with spondylolisthesis and segmental instability represents an indication for fusion rather than decompression alone; the prior laminectomy alters the surgical field and requires careful neural identification and tissue handling at re-entry. Second, bilateral foraminal stenosis with severe facet arthropathy and facet disruption at an adjacent level may require foraminal decompression as a component of the fusion procedure, not only central decompression. Third, when UBE-TLIF is performed at two adjacent levels in a revision setting, operative sequencing, level confirmation, and neural protection at each stage are important technical considerations; this is presented as a case-specific teaching observation and should not be interpreted as a general outcome claim.
Published images and video
Media are identified by their public source. Journal figures open at the original source; operative video illustrates a technical example. Imaging and operative appearances do not measure pain relief, function, or durable fusion.
preoperative imaging
postoperative imaging
Reported observations and missing data
Values below are limited to what the identified public source reports; source charts were not re-audited for this website update. Operative-time definitions and observation windows may differ. Do not compare these values across surgeons or procedures.
- Operative time
- Not reported in the available educational summary.
- Estimated blood loss
- Not reported in the available educational summary.
- Hospital stay
- Not reported in the available educational summary.
- Complications
- Not reported in the available educational summary.
- Follow-up interval
- Not reported in the available educational summary.
- Validated patient-reported outcome scores
- Not reported in the available educational summary.
Evidence and further reading
These sources provide clinical context. They are separate from the source records for this case and do not verify its outcome.
Coauthored publication · technical report
Biportal Endoscopic Spinal Surgery for Recurrent Lumbar Disc HerniationsChoi DJ, Jung JT, Lee SJ, Kim YS, Jang HJ, Yoo B. Clin Orthop Surg. 2016;8(3):325–329.
A published technical discussion of biportal revision discectomy, scar dissection, and preservation of remaining stabilizing structures.
Applicability: This report concerns recurrent disc herniation. It does not establish the benefit of revision fusion or validate outcomes in the cases on this website.
External evidence · randomized trial
Decompression alone or with fusion for degenerative lumbar spondylolisthesis (Nordsten-DS): five year follow-upKgomotso EL et al. BMJ. 2024;386:e079771.
At five years, decompression alone was non-inferior to decompression with instrumented fusion in the trial population.
Applicability: Patient selection and exclusions matter. These findings do not establish that every slip needs fusion, nor compare UBE-TLIF with all alternative techniques.
Source, authorship, and limitations
Source material: Hanjin Jang, MD academic case collection. Case 07 in the previously published Case-Based Education collection by Hanjin Jang, MD. A separate case-level clinical review date and public consent record are not reported in the available source. This entry was organized on 2026-09-11; this date records a website update, not a new clinical review.
Selection is educational. No population denominator, consecutive recruitment process, comparative group, or complete follow-up dataset is supplied. A missing complication field does not mean that no complication occurred. Published observations do not predict another patient's outcome.
No new private patient files were added in this update. Corrections and future clinical additions follow the editorial policy.
Suggested citation: Hanjin Jang, MD academic case collection. UBE-TLIF L4-5-S1 for Post-laminectomy Recurrent Stenosis and Bilateral Foraminal Stenosis. Casebank, Case 07. Updated 2026-09-11. https://www.hanjinjangspine1.com/casebank/post-laminectomy-two-level-ube-tlif