Transforaminal endoscopic discectomy with temporary percutaneous pedicle screw fixation as a fusion-sparing approach for giant recurrent L4/5 disc herniation and iatrogenic pars fracture in a young female: a case report.

Background: Reoperation after lumbar discectomy for recurrent disc herniation can be technically challenging due to surgical scarring and altered anatomy, especially if postoperative complications are present. Iatrogenic pars fractures are a rare but significant post-operative complication that can complicate management with potential to cause persistent back pain, radiculopathy, and progression to instability, particularly in young active patients if not treated appropriately. Case Description: The authors present the case of a 37-year-old female who presented with cauda equina syndrome following recent open lumbar laminectomy and discectomy, with imaging showing giant recurrent disc herniation and iatrogenic pars fracture. Patient underwent endoscopic transforaminal discectomy and temporary percutaneous pedicle screw fixation, with delayed hardware removal following fracture union. At follow-up, she demonstrated complete radiological cauda equina decompression and near-complete clinical recovery, with only minor residual sensory symptoms and preserved motion at that segment following hardware removal. Conclusions: This case demonstrates that a minimally invasive endoscopic approach to discectomy combined with temporary pedicle screw fixation may be a promising motion-preserving alternative in select cases of recurrent disc herniation and iatrogenic pars fracture in younger patients.