Transforaminal Full-Endoscopic Surgery for Lumbar Foraminal Pathologies: A Comparative Clinical Effectiveness Study

Introduction: Full-endoscopic surgery for the treatment of lumbar foraminal pathology is gaining popularity, but indications remain poorly defined.

Methods: Multicenter cohort study of patients with intervertebral lumbar foraminal pathology who underwent full-endoscopic decompression at four medical centers. Postoperative patient-reported outcomes, including low back and leg pain as well as Oswestry Disability Index (ODI) scores, were prospectively tracked using a mobile app for 6 months. 6-month outcome measures (PROMs) were used as the primary outcome variable to determine treatment effectiveness with regard to various foraminal pathologies.

Results: Eighty-three patients with a mean age of 57.04 years were included. The most common operative levels were L4/5 for transforaminal endoscopic discectomies (59.6%) and L5/S1 for endoscopic foraminotomies (58.1%). Endoscopic discectomies resulted in significant improvements in Visual Analog Scale (VAS) scores for low back pain (from 5.85 to 3.02), leg pain (from 6.66 to 3.12), and ODI scores (from 24.39 to 12.32). Endoscopic foraminotomies also resulted in significant improvements in VAS scores for low back pain (from 5.58 to 3.68) and leg pain (from 6.42 to 4.21), as well as ODI scores (from 19.28 to 14.67). The amount of improvement was independent of the severity of foraminal stenosis as determined on preoperative magnetic resonance imaging (MRI). However, vertical foraminal stenosis was associated with the lowest treatment response rate.

Conclusion : Endoscopic foraminotomies result in clinically meaningful symptomatic improvement for most lumbar foraminal pathologies. However, the effectiveness of decompression surgery for vertical foraminal stenosis was limited and requires further investigation.