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An algorithm for selection of full endoscopic approach for symptomatic nerve root decompression – Lumbar Spinal Stenosis

The article proposes a new surgical nomenclature and algorithm for selecting the appropriate approach for endoscopic decompression in patients with lumbar compressive radiculopathy. The study included 396 patients who underwent either a transforaminal (TF) or interlaminar (IL) endoscopic approach. MRI findings were classified using the FAPDIS algorithm, and inter-observer agreement was calculated. The results showed good correlation for most FAPDIS factors, except for the selection of certain pathologies. The overall VAS score and Oswestry Disability Index score improved significantly after surgery. The authors conclude that their FAPDIS surgical nomenclature and algorithm are reliable tools for selecting the endoscopic surgical approach to achieve adequate decompression with minimal perioperative complications

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : most specialised spinal facility in UK

Published article

CONCLUSIONS: The author’s new FAPDIS surgical nomenclature and algorithm is a reliable tool for describing the symptomatic nerve root compression for the selection of endoscopic surgical approach to achieve adequate decompression of offending neural structure with minimum challenges to minimize perioperative complication rate.

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N Am Spine Soc J. 2023 Jul 16;15:100244. doi: 10.1016/j.xnsj.2023.100244. eCollection 2023 Sep.ABSTRACTBACKGROUND CONTEXT: Both Transforaminal (TF) and Interlaminar (IL) endoscopic approaches are established techniques of decompression for lumbar compressive radiculopathy. In the absence of adequate literature, there is always some dilemma in selecting the approach for endoscopic decompression leading to long learning curves and,

N Am Spine Soc J. 2023 Jul 16;15:100244. doi: 10.1016/j.xnsj.2023.100244. eCollection 2023 Sep.

ABSTRACT

BACKGROUND CONTEXT: Both Transforaminal (TF) and Interlaminar (IL) endoscopic approaches are established techniques of decompression for lumbar compressive radiculopathy. In the absence of adequate literature, there is always some dilemma in selecting the approach for endoscopic decompression leading to long learning curves and high chances of inadequate decompression, iatrogenic instability, dural tear, or dysesthesia. Hence authors propose a new surgical nomenclature and algorithm for selection of endoscopic approach.

METHODS: This retrospective study included 396 of 626 consecutive patients who met the inclusion criteria, who underwent either TF (n=302) or IL (n=202) full endoscopic spine surgery. MRI findings of every patient were classified as per FAPDIS (Facet angle, Anterior pathology, Posterior pathology, Dorsal, Inferior, and Superior migration) algorithm. Inter-observer variations were calculated. The targeted nomenclature was used to define the selection of endoscopic TF or IL approach for symptomatic nerve root decompression. All patients were followed up for preop and postop 6 months VAS and Oswestry Disability Index score for validation of FAPDIS algorithm.

RESULTS: Median age: 46.8 years; Sides and levels operated 330 single-level ipsilateral, 54 multiple-level ipsilateral, 6 single-level bilateral, and 6 multiple-level bilateral. Interobserver agreement in the selection of TF approach was 0.873 and IL approach was 0.882. Interobserver variability was also calculated for each FAPDIS factor, selection of P3 and P4 pathology was the main reason for disagreement. All other FAPDIS factors show good to excellent correlation. The overall VAS score decreased from a preoperative value of 9 to 1 at 6 months follow-up (p-value < 0.001), and the overall Oswestry Disability Index score improved from 89 to 12 (p-value <.001).

CONCLUSIONS: The author’s new FAPDIS surgical nomenclature and algorithm is a reliable tool for describing the symptomatic nerve root compression for the selection of endoscopic surgical approach to achieve adequate decompression of offending neural structure with minimum challenges to minimize perioperative complication rate.

PMID:37546166 | PMC:PMC10403736 | DOI:10.1016/j.xnsj.2023.100244

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An algorithm for selection of full endoscopic approach for symptomatic nerve root decompression

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N Am Spine Soc J. 2023 Jul 16;15:100244. doi: 10.1016/j.xnsj.2023.100244. eCollection 2023 Sep.ABSTRACTBACKGROUND CONTEXT: Both Transforaminal (TF) and Interlaminar (IL) endoscopic approaches are established techniques of decompression for lumbar compressive radiculopathy. In the absence of adequate literature, there is always some dilemma in selecting the approach for endoscopic decompression leading to long learning curves and

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