Abstract
Objective: This study focused on the efficacy of endoscopic decompression of the foramen guided by endoscopic aware-state pain source definition. Background Data: Endoscopic foraminoplasty consists of undercutting of the facet joint and endoscopic discectomy, mobilization and neurolysis of the exiting and transiting nerves, and ablation of osteophytes. This study sought the outcome of endoscopic foraminoplasty in 250 consecutive patients followed for a minimum of 2 years, reviewed and assessed by an external independent assessor. It was applied to patients with back pain and sciatica in multilevel degenerative disc disease and also to those with prior surgery. Methods: A prospective study of endoscopic laser foraminoplasty was performed on 121 males and 129 females with an average age of 48 years (21–86 years), followed for an average period of 30 months (26–43 months). The average preoperative duration of back, buttock, or leg pain was 6.1 years (5–11 years). A total of 30% had undergone prior open spinal surgery. Results: The cohort integrity at follow up was 97%. Outcome was analyzed using the percentage change in Oswestry Disability Scores and visual analogue pain scores. Clinically relevant change in pain and disability was observed in 73%. Using a percentage change in Oswestry Disability Score of 50 or more to determine good and excellent outcomes, 60% of patients exceeded this score. A total of 95% patients required no further surgical intervention. Conclusions: Endoscopic laser foraminoplasty provides a minimalist means of exploring the extraforaminal zone, the foramen, the disc, and the epidural space and performing discectomy, lateral recess decompression, osteophytectomy, and neural mobilization. Performed in the aware state, it serves to identify and localize precisely the causal source of pain in multilevel disc disease, in revision surgery, and in the infirm and elderly without open fusion or decompression.
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