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Clinical and Radiographic Outcomes After Single-level Biportal Endoscopic Lumbar Paraspinal Foraminal Decompression.

Ju-Eun Kim1, Eugene J Park, Ho-Jin Lee

  • 1From the Baroseomyeon H-ospital, Busan, Korea (Dr. Kim); the Department of Orthopedic Surgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, South Korea (Dr. E. J. Park); the Department of Orthopedic Surgery, Chungnam National University College of Medicine, Daejeon, Korea (Dr. Lee); the Department of Orthopedic Surgery, Corewell Hospital, Royal Oak, MI (Dr. Zakko); and the Midwest Orthopedics at RUSH Chicago, IL (Dr. D. K. Park).

Journal of the American Academy of Orthopaedic Surgeons. Global Research & Reviews
|December 18, 2025
PubMed
Summary
This summary is machine-generated.

Biportal endoscopic-foraminal decompression (BE-FD) shows good outcomes for lumbar foraminal stenosis, with 69.5% achieving excellent results. Preoperative factors like disc height and wedging can predict less successful outcomes.

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Area of Science:

  • Neurosurgery
  • Orthopedic Surgery
  • Minimally Invasive Spine Surgery

Background:

  • Intermediate outcomes of biportal endoscopic-foraminal decompression (BE-FD) for lumbar foraminal stenosis are not well-documented.
  • Evaluating clinical and radiologic results of BE-FD is crucial for understanding its effectiveness.
  • Identifying risk factors for suboptimal outcomes after BE-FD is essential for patient selection and surgical planning.

Purpose of the Study:

  • To assess the clinical and radiologic outcomes of BE-FD for lumbar foraminal stenosis.
  • To identify preoperative and intraoperative factors associated with less successful outcomes following BE-FD.

Main Methods:

  • A cohort of 141 patients undergoing single-level BE-FD for lumbar foraminal stenosis was retrospectively analyzed.
  • Clinical outcomes were evaluated using the Oswestry Disability Index and Visual Analog Scale (VAS) for back and leg pain.
  • Radiographic parameters including intervertebral disc height (IVD), foraminal height (FH), and disc wedging (DW) were assessed preoperatively and postoperatively.

Main Results:

  • Overall, 69.5% of patients achieved excellent outcomes with BE-FD.
  • Patients with less satisfactory results showed improvement in Oswestry Disability Index and VAS leg pain, but less than the excellent outcome group.
  • Smaller preoperative IVD and FH, greater preoperative DW, and larger changes in these parameters were associated with poorer outcomes.
  • 9.9% of patients required revision fusion surgery.

Conclusions:

  • BE-FD is an effective technique for lumbar foraminal stenosis, providing significant symptom improvement with a low revision rate.
  • Preoperative factors such as lower IVD and FH, and higher DW, particularly in the lower lumbar spine, are associated with potentially less favorable outcomes.
  • Caution and careful consideration are advised for patients with these risk factors when planning BE-FD.