The article discusses the dilemma in selecting the appropriate approach for endoscopic decompression in cases of lumbar compressive radiculopathy. The authors propose a new surgical nomenclature and algorithm for the selection of either Transforaminal (TF) or Interlaminar (IL) endoscopic approach. The study included 396 patients who underwent either TF or IL endoscopic spine surgery, and their MRI findings were classified according to the FAPDIS algorithm. The results showed good agreement in the selection of the approach, with the main reason for disagreement being the selection of certain pathologies. The overall outcomes were positive, with significant improvement in VAS scores and Oswestry Disability Index scores. The authors conclude that their new nomenclature and algorithm are reliable tools for selecting the appropriate endoscopic surgical approach for adequate decompression and minimizing complications
Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : most advanced treatment clinic 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.
Lumbar Decompression Surgery Expert. Best Spinal Surgeon UK
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
The London Spine Unit : most advanced treatment clinic in UK
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An algorithm for selection of full endoscopic approach for symptomatic nerve root decompression
