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Related Experiment Video

Updated: Jul 19, 2025

Author Spotlight: Scope of LE-ULBD as a Safe, Effective, and Minimally Invasive Approach to Treat Lumbar Spinal Stenosis
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Author Spotlight: Scope of LE-ULBD as a Safe, Effective, and Minimally Invasive Approach to Treat Lumbar Spinal Stenosis

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

Prasad Patgaonkar1, Vaibhav Goyal1, Pratik Patel1

  • 1Indore Spine Centre, 5-6 RS Bhandari Marg, Indore, Madhya Pradesh 452009, India.

North American Spine Society Journal
|August 7, 2023
PubMed
Summary
This summary is machine-generated.

A new FAPDIS algorithm aids in selecting endoscopic spine surgery approaches for lumbar radiculopathy, improving outcomes. This tool helps surgeons choose between Transforaminal (TF) and Interlaminar (IL) endoscopic decompression, reducing complications.

Keywords:
AlgorithmApproach selectionFAPDISFull endoscopic spine surgeryInterlaminarTransforaminal

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Area of Science:

  • Neurosurgery
  • Orthopedic Surgery
  • Minimally Invasive Spine Surgery

Background:

  • Lumbar compressive radiculopathy presents challenges for endoscopic decompression.
  • Selecting between Transforaminal (TF) and Interlaminar (IL) endoscopic approaches lacks clear guidelines, leading to potential complications.
  • A novel surgical nomenclature and algorithm are proposed to standardize approach selection.

Purpose of the Study:

  • To introduce and validate the FAPDIS (Facet angle, Anterior pathology, Posterior pathology, Dorsal, Inferior, and Superior migration) algorithm for selecting endoscopic decompression approaches.
  • To establish a reliable method for describing nerve root compression in lumbar radiculopathy.
  • To improve the selection process for TF or IL endoscopic surgery.

Main Methods:

  • Retrospective analysis of 396 patients undergoing TF or IL full endoscopic spine surgery.
  • Classification of MRI findings using the FAPDIS algorithm.
  • Evaluation of inter-observer agreement for approach selection and FAPDIS factors.
  • Pre- and post-operative assessment of Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores at 6 months.

Main Results:

  • High inter-observer agreement for TF (0.873) and IL (0.882) approach selection.
  • FAPDIS factors, particularly P3 and P4 pathology, showed minor disagreement, while others correlated well.
  • Significant reduction in VAS scores (9 to 1) and ODI scores (89 to 12) post-surgery (p < 0.001).

Conclusions:

  • The FAPDIS nomenclature and algorithm provide a reliable tool for selecting endoscopic surgical approaches.
  • This systematic approach aids in achieving adequate decompression with minimized perioperative complications.
  • The algorithm facilitates precise description of nerve root compression for optimal surgical planning.