Awake full-endoscopic transforaminal lumbar interbody fusion via the trans-Kambin approach under local anaesthesia in a nonagenarian.

Degenerative lumbar spine disease is common in the elderly, but spinal fusion is often avoided in patients over 90 years due to perceived risks of surgical or anaesthesia-related complications. Full-endoscopic transforaminal lumbar interbody fusion (FE-TLIF) via the trans-Kambin approach offers a minimally invasive alternative that can be performed without general anaesthesia. We report a nonagenarian patient with recurrent symptomatic foraminal stenosis at L4-L5 after prior decompression surgeries who underwent FE-TLIF under local anaesthesia. The procedure was well tolerated, with significant pain relief, early mobilisation and radiological evidence of initial fusion at 10 months follow-up. This case illustrates that age alone should not be considered an absolute contraindication for spinal fusion. Surgical decision-making should prioritise physiological rather than chronological age, and in experienced hands, endoscopic spinal fusion may represent a safe and effective treatment option even in carefully selected nonagenarians.