Full-Visualization Endoscopic Paravertebral (Extraforaminal) Decompression Under Local Anesthesia for Far-Out Syndrome: A Consecutive Case Series of 27 Patients
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Updated: Oct 30, 2026
Circumferential Transforaminal Endoscopic Lumbar Foraminotomy for 360° Exiting Nerve Root Decompression in Patients with Lumbar Foraminal Stenosis
Published on: July 28, 2026
Yihua Shi1, Chenhao Sun2, Sheng Zhou1
1Department of Orthopedics, Xiangyang No. 1 People's Hospital, Hubei University of Medicine, Xiangyang, 441000, China.
Objective:
To evaluate the clinical efficacy of full-visualization spinal endoscopic decompression technique performed under local anesthesia for Far-out syndrome (FOS) and to describe its technical nuances.
Methods:
Between March 2023 and March 2025, 27 consecutive FOS patients underwent full-visualization spinal endoscopic decompression via a single-portal paravertebral approach under local anesthesia. This approach allows medial extension of decompression into the intraforaminal zone when necessary to achieve adequate release of the L5 exiting nerve root. Clinical outcomes were assessed using VAS, ODI, and modified MacNab criteria preoperatively and at 3 days, 1, 3, and 12 months postoperatively. Key procedural steps were detailed, and outcomes compared with literature.
Results:
Mean age was 69 ± 12 years; mean operative time 102 ± 28 min.
Pathology:
33% pure bony stenosis, 67% combined with disc herniation. VAS improved from 7.5 ± 0.9 preoperatively to 1.5 ± 1.1 at 12 months (P < 0.0001). ODI decreased from 71 ± 5% to 16 ± 7% (P < 0.0001). MacNab criteria: 89% excellent/good, 7.4% fair, 3.7% poor. Suboptimal outcomes: one preoperative level misidentification, one residual radicular symptom, and one epineurial tear (no deficit). Comparative analysis confirmed favorable outcomes versus other techniques.
Conclusion:
Full-visualization spinal endoscopic decompression under local anesthesia is effective and safe for FOS, offering real-time patient feedback, avoidance of general anesthesia, and minimal tissue trauma, making it suitable for the often-elderly FOS population.
