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Biportal endoscopic paraspinal decompressive foraminotomy for lumbar foraminal stenosis: clinical outcomes and factors influencing unsatisfactory outcomes

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Abstract

Background

Lumbar foraminal stenosis (LFS) is an important pathologic entity that causes lumbar radiculopathies. Unrecognized LFS may be associated with surgical failure, and LFS remains challenging to treat surgically. This retrospective cohort study aimed to evaluate the clinical outcomes and prognostic factors of decompressive foraminotomy performed using the biportal endoscopic paraspinal approach for LFS.

Methods

A total of 102 consecutive patients with single-level unilateral LFS who underwent biportal endoscopic paraspinal decompressive foraminotomy were included. We evaluated the Visual Analogue Scale (VAS) score and the Oswestry Disability Index (ODI) before and after surgery. Demographic, preoperative data, and radiologic parameters, including the coronal root angle (CRA), were investigated. The patients were divided into Group A (satisfaction group) and Group B (unsatisfaction group). Parameters were compared between these two groups to identify the factors influencing unsatisfactory outcomes.

Results

In Group A (78.8% of patients), VAS and ODI scores significantly improved after biportal endoscopic paraspinal decompressive foraminotomy (p < 0.001). However, Group B (21.2% of patients) showed higher incidences of stenosis at the lower lumbar level (p = 0.009), wide segmental lordosis (p = 0.021), and narrow ipsilateral CRA (p = 0.009). In the logistic regression analysis, lower lumbar level (OR = 13.82, 95% CI: 1.33–143.48, p = 0.028) and narrow ipsilateral CRA (OR = 0.92, 95% CI: 0.86–1.00, p = 0.047) were associated with unsatisfactory outcomes.

Conclusions

Significant improvement in clinical outcomes was observed for a year after biportal endoscopic paraspinal decompressive foraminotomy. However, clinical outcomes were unsatisfactory in 21.2% of patients, and lower lumbar level and narrow ipsilateral CRA were independent risk factors for unsatisfactory outcomes.

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Data Availability

The datasets used and analyzed during the current study available from the corresponding author on reasonable request.

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Acknowledgements

We would like to thank Editage (www.editage.co.kr) for English language editing.

Funding

This research was supported by the Hallym University Research Fund 2021 (HURF-2021–31).

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Author notes

  1. Ki-Han You and Min-Seok Kang contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopedic Surgery, Spine Center, Hallym University College of Medicine, Kangnam Sacred Heart Hospital 1, Singil-Ro, Yeongdeungpo-Gu, Seoul, 07441, Republic of Korea

    Ki-Han You, Jae-Yeun Hwang, Jin-Tak Hyun & Hyun-Jin Park

  2. Department of Orthopedic Surgery, Korea University College of Medicine, Anam Hospital, Seoul, Republic of Korea

    Min-Seok Kang

  3. Department of Orthopedic Surgery, Anseong St.Mary Hospital, Gyeonggi-Do, Republic of Korea

    Woo-Myung Lee

  4. Department of Radiology, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, Seoul, Republic of Korea

    Ik Yang

  5. Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Republic of Korea

    Sang-Min Park

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Correspondence to Hyun-Jin Park.

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Ethics approval

This study was approved by the Institutional Review Board of Hallym University Kangnam Sacred Heart Hospital (HKS2022-01–002).

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Comments

This is a morphological preoperative study and report of surgical result by decompressing the lumbar nerve root at a critically narrowed intervertebral foramen. They produce evidence of the LFS and explains the role of coronal T2 weighted calculations of the angle between lateral dural sac and nerve root. What remains to be at the focus of a neurological surgeon of the spine, to my personal opinion is the neurological physical examination. The neurological status of the patient should be assessed carefully and thoroughly with regard to differentiate radiculopathy due to LFS, from myofascial pain syndromes, or peripheral entrapment neuropathy. To my personal surgical experience recognition of such neurological clinical entities and elaboration with electrophysiological studies should precede the indication to LFS. As for the methods of decompression, be it endoscopical or microscopical, it depends on the expertise of the surgeon. To my opinion the most important aspect of LFS surgery is to decompress the nerve root with less soft tissue damage possible. The present study I believe demonstrates very well such a method.

Ridvan H Alimehmeti

Tirana,Albania

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You, KH., Kang, MS., Lee, WM. et al. Biportal endoscopic paraspinal decompressive foraminotomy for lumbar foraminal stenosis: clinical outcomes and factors influencing unsatisfactory outcomes. Acta Neurochir 165, 2153–2163 (2023). https://doi.org/10.1007/s00701-023-05706-3

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