Full-Endoscopic Transforaminal Decompression with Modified Reaming Technique on Lateral Recess Stenosis: Outcomes of 155 Cases and Five Years' Experience. A Case Series Study

Abstract

Objective

Lateral recess stenosis is a degenerative condition caused by a bulging disc, hyperplasia of the superior articular process, and hypertrophy of the ligamentum flavum. The advancement of transforaminal endoscopic lumbar approaches provides effective treatment not only for migrated herniation but also for stenosis. We outlined a modified nonsequential foraminoplasty technique utilizing a trephine and conducted a comprehensive review of our cases to demonstrate safety and efficacy of the procedure.

Methods

Patients with lumbar radiculopathy refractory to conservative treatment, diagnosed with magnetic resonance imaging and diagnostic root blocks, and underwent full-endoscopic transforaminal decompression with the modified nonsequential foraminoplasty technique between April 2017 and September 2022 were included. Those with multiple-level stenosis, previous surgery at the same level, unstable spondylolisthesis, lumbar herniated disc without stenosis, infection, fracture, or tumor were excluded. The study recorded the visual analog scale, Oswestry Disability Index, Modified Macnab criteria, as well as intraoperative and postoperative complications.

Results

One hundred fifty-five patients were included in the study. Clinical and postoperative outcomes revealed significantly lower back and leg visual analog scale scores, as well as Oswestry Disability Index scores at various postoperative time points compared to preoperative values (P < 0.01). At the final follow-up, the modified MacNab criteria were rated as follows: excellent in 65 patients (41.9%), good in 60 patients (38.7%), fair in 2 patients (1.2%), and poor in 28 patients (18.0%).

Conclusions

Full-endoscopic transforaminal decompression using a modified nonsequential foraminoplasty technique is an effective and safe treatment for lumbar lateral recess stenosis.