End-points of Decompression of in Lumbar Transforaminal Endoscopic Spine Surgery: A Narrative Review of Objective and Subjective Criteria to Prevent Failures

Abstract

Objective: Executions of indications/extended indications are associated with higher than normal rates of symptomatic recurrences and treatment failures, especially for novice surgeons incorporating Percutaneous Transforaminal endoscopic lumbar discectomy/decompression (PTELD) techniques. Causes of failures can be manifold and can occur because of a residual or a complete fragment causing persistent compression or associated unaddressed stenosis. To prevent this problem, proper training, multiple instrument inventory, variable techniques are needed with progressive learning. Authors aim to suggest objective and subjective criteria to define end-points/adequacy of decompression (EPD).Methods: PubMed database search was limited to locate only adequacy of decompression of PTELD and thus included specific keywords: “ENDPOINT” OR “ADEQUATE” AND “DECOMPRESSION” AND “TRANSFORAMINAL” AND “ENDOSCOPY”. Authors added their experience to refine and define multiple EPD.Results: In the search we found 12 articles total. Upon reviewing these, we found 7 articles matching our criteria. Cross references of included articles were searched, 5 additional articles were included. EPD were described in only 9 articles. Author’s experience with other relevant references were added to complete the viewpoint (EPD, n=29). Direct observed/ provoked EPD and inferred EPD were defined separately. Videos, illustrations and descriptions of each EPD are illustrated to provide the ideation.Conclusion: EPD are variable and not all signs may be elicited in every case and may change with surgeon experience. The ability to recognize EPD is the crux for successful outcomes and maximum possible EPD’s should be aimed in every surgery to avoid failures.

Investigating the impact of cartilaginous endplate herniation on recovery from percutaneous endoscopic lumbar discectomy

“…Some studies [ 22 ] suggest that for cases with endplate damage, PRAF, and failure at the endplate junction, the endpoint of decompression changes. Among the surgical patients participating in this study, the endpoint of surgical decompression was consistent.…”

Comparative outcomes of obese and non-obese patients with lumbar disc herniation receiving full endoscopic transforaminal discectomy: a systematic review and meta-analysis

“…Among these, postoperative radicular sensory abnormalities emerge as the most common complication, often attributed to overstimulation or nerve root damage. Prudent preoperative evaluation and a gentle operative approach are crucial in mitigating the risk of this complication [ 30 ]. Dural tears, often encountered in inexperienced practitioners or cases with substantial subdural scar tissue adhesion, underscore the importance of meticulous and cautious surgical procedures to prevent iatrogenic injury.…”

Clinical Effect of Minimally Invasive Microendoscopic‐Assisted Transforaminal Lumbar Interbody Fusion for Single‐Level Lumbar Disc Herniation

“…Lumbar disc herniation (LDH) with lumbar instability is a common cause of low back pain, radiculopathy, and/or neurogenic claudication 1,2 . Patients with LDH prefer to choose surgical decompression of the neural elements and stabilize spinal fusion after invalid non‐operative treatment 3,4 . Currently, transforaminal lumbar interbody fusion (TLIF) and posterior lumbar interbody fusion (PLIF) are two widely used types of surgery for LDH therapy 5–7 .…”

“… 1 , 2 Patients with LDH prefer to choose surgical decompression of the neural elements and stabilize spinal fusion after invalid non‐operative treatment. 3 , 4 Currently, transforaminal lumbar interbody fusion (TLIF) and posterior lumbar interbody fusion (PLIF) are two widely used types of surgery for LDH therapy. 5 , 6 , 7 The indications for lumbar interbody fusion mainly include: low back pain, lumbar disc herniation, neurogenic claudication, radiculopathy due to foraminal stenosis, spinal instability, and lumbar degenerative spinal deformity that includes symptomatic spondylolisthesis, and degenerative scoliosis.…”