Five-year clinical outcomes with endoscopic transforaminal outside-in foraminoplasty techniques for symptomatic degenerative conditions of the lumbar spine

Lumbar Endoscopic Bony and Soft Tissue Decompression With the Hybridized Inside-Out Approach: A Review And Technical Note

“…The hybridized version of transforaminal endoscopy consisting of an initial "outside-in" approach with decompression in the epidural space followed by the intradiscal "inside-out" decompression under direct visualization is a result of years of outcome research recently published by the authors. 3,33 Fiveyear follow-up data clearly showed lower reoperation rates if the "inside-out" treatment of intradiscal pain generators was included in the transforaminal decompression surgery. 33 Consequently, the authors started combining the 2 techniques sometimes in different order of steps but eventually arriving at the same end-result-a combined "outside-in" and "inside-out" endoscopic decompression procedure to treat pain generators in the epidural space as well as inside the disease intervertebral disc.…”

“…The hybridized version of transforaminal endoscopy consisting of an initial “outside-in” approach with decompression in the epidural space followed by the intradiscal “inside-out” decompression under direct visualization is a result of years of outcome research recently published by the authors [ 3 , 33 ]. Fiveyear follow-up data clearly showed lower reoperation rates if the “inside-out” treatment of intradiscal pain generators was included in the transforaminal decompression surgery [ 33 ].…”

“…1,2 Strategies to deal with the increased demand for these types of procedures with the aging babyboomer population advancing into their retirement years is stressing the resource-strapped health care systems to a point where the stakeholders are being motivated to come up with better-valued solutions to avoid rationing of traditional open spine surgery. 3,4 Patients have also changed their stance on spine surgery seeking out spine surgeons who provide personalized spine care in the context relevant to the patients' complaints at the time when the care is delivered by treating validated pain generators rather than basing decision for surgical treatment on traditional image-based criteria. [5][6][7][8][9] Instead, the authors have proposed for years a staged management approach limiting endoscopic spine care to the lumbar level to which the patients' subjective weakness, and intermittent claudication limiting walking endurance and other physical activities can be traced back to.…”

“…In the United States, endoscopic spinal surgery is being positioned by its prominent key opinion leaders to meet the need for simplified, less burdensome, and more cost-effective spinal decompression surgeries [ 1 , 2 ]. Strategies to deal with the increased demand for these types of procedures with the aging babyboomer population advancing into their retirement years is stressing the resource-strapped health care systems to a point where the stakeholders are being motivated to come up with better-valued solutions to avoid rationing of traditional open spine surgery [ 3 , 4 ]. Patients have also changed their stance on spine surgery seeking out spine surgeons who provide personalized spine care in the context relevant to the patients’ complaints at the time when the care is delivered by treating validated pain generators rather than basing decision for surgical treatment on traditional image-based criteria [ 5 - 9 ].…”

Feasibility of Using Intraoperative Neuromonitoring in the Prophylaxis of Dysesthesia in Transforaminal Endoscopic Discectomies of the Lumbar Spine

“…Therefore, the authors decided to retrospectively study the result obtained by using neuromonitoring during transforaminal videoendoscopy in patients who were treated for herniated discs. While the three senior key opinion leader (KOL) surgeons (JFRL, ATY, and KUL) of this article have performed over 18,000 endoscopic spine surgeries between them [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ] under monitored local anesthesia care (MAC) and sedation [ 12 , 18 , 19 ] with minimal complications [ 1 , 20 ] and utilizing the patients’ direct intraoperative feedback to treat validated pain generators [ 11 , 15 , 19 , 21 , 22 ], they recognize that neuromonitoring in some countries and in some clinical settings is the standard of care [ 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ] in spite of added cost [ 33 ]. In some instances, it may even be a matter of necessity if MAC protocols for spine surgery are not supported by the local anesthesia teams.…”