Arthroscopic-assisted Uni-portal Spinal Surgery (AUSS) with a far-lateral and extraforaminal approach for lumbar chondroma: a case report and literature review

BACKGROUND: Lumbar spinal chondroma (LSC) is a rare benign tumor.Most LSCs are located in the epidural space, and some exhibit a dumbbell-shaped growth pattern. Its presentation mimics lumbar disc herniation, leading to frequent misdiagnosis. While hemilaminectomy has been the conventional treatment, we report a case successfully managed with a novel technique: Arthroscopic-assisted Uni-portal Spinal Surgery (AUSS) via a far-lateral extraforaminal approach. CASE PRESENTATION: We report a 42-year-old male with recurrent left lower limb radicular pain for one year. Preoperative MRI revealed an L4/5 extraforaminal lesion causing nerve compression. Using the AUSS technique through a single far-lateral portal under arthroscopic guidance, complete tumor resection and nerve decompression were achieved. Postoperative imaging and outcomes were assessed (Table 2). Results: The patient's radicular pain resolved completely postoperatively. Imaging confirmed total tumor excision, adequate decompression, and no radiographic evidence of instability at short-term follow-up. No complications occurred. Histopathology confirmed chondroma. CONCLUSIONS: The AUSS technique with a far-lateral extraforaminal approach is a safe and effective minimally invasive option for resecting lumbar chondroma. It ensures complete tumor removal and neural decompression while minimizing tissue trauma and promoting rapid recovery, representing a viable minimally invasive alternative to conventional open surgery, particularly suitable for LSCs located in the extraforaminal region.