Biportal endoscopic foraminotomy of the L7-S1 neuroforamen in dogs: Description of surgical technique and ex vivo comparison with conventional open dorsolateral foraminotomy.

To describe low-field MRI findings associated with lumbosacral foraminal stenosis and radiculopathy and correlate these with clinical signs. Retrospective study. Client-owned dogs (n = 240) that underwent a clinical examination and standardized MRI protocol of the lumbosacral junction. Medical records of dogs with degenerative lumbosacral stenosis with neurological clinical evaluation and MRI of the lumbosacral junction were used to describe imaging pathologies and relate them to clinical status. In total, 480 L7 neuroforamina were evaluated. A loss of foraminal fat signal was identified in 364 of 480 neuroforamina of which 87.9% (n=320) showed also concurrent nerve root changes. Magnetic resonance imaging features of L7 radiculopathy included nerve root enlargement and hyperintensity to surrounding connective tissue in dorsal oblique gradient echo short time inversion recovery sequences and specific changes in shape, size, or position of the nerve root in transverse T1-weighted sequences. Radiculopathy was noted as a consequence of either circumferential (entrapment) or focal (impingement) foraminal stenosis. Lateral vertebral spondylotic and intervertebral facet joint changes were the most common underlying spinal and neuroforaminal pathologies. Clinical signs were present in the ipsilateral hind leg in 85% (n = 65) of dogs with unilateral lumbosacral imaging findings. A loss of foraminal fat signal was likely to be associated with L7 radiculopathy and foraminal stenosis. Unilateral lesions were generally associated with clinical signs on the ipsilateral limb. Loss of foraminal fat signal revealed by low-field MRI should prompt the assessment of concurrent radiculopathy and underlying stenosis, and in coherence with clinical findings, when is combined with clinical findings, improves the diagnosis of lumbosacral foraminal stenosis.

BackgroundThe SurgiFile (SurgiFile, Inc., Carlsbad, California) is a specialized tool designed for the treatment of lateral recess and foraminal stenosis that allows surgeons to internally expand and decompress the entire length of the neural foramen while preserving the integrity of the overlying facet complex.MethodsWe used two cadaveric specimens in this study. After they removed the lamina and spinous processes of L2, L3, L4, and L5 from the dorsal spine, fellowship-trained spinal surgeons used the standard tools and the SurgiFile to the best of their experience and ability on alternating sides of each level to decompress the lateral recess and neural foramen while still preserving at least 50% of the dorsal facet complex. Using preoperative and postoperative fine-cut CT scans with axial and sagittal reconstructions, we evaluated the degree of decompression and the amount of preserved facet complex using analytical tests and recording the measurements.ResultsThe difference between the proximal recess and lateral foramen of the groups was statistically significant in the axial CT images. On sagittal reconstruction CT images, the difference between the two groups was significant (P < 0.05, Wilcoxon) only for the lateral foramen. Although a strong trend toward better area change was evident for the proximal recess measurements in the experimental tool sides, this did not achieve statistical significance. Macroscopic and CT scans measurements showed that the amount of facetectomy for adequate decompression with the SurgiFile was less than the amount achieved with the standard tools.ConclusionsFor the treatment of spinal stenosis, this novel powered-file instrument provides surgeons with a new means of decompressing the lateral recess and neural foramina. In this cadaveric study, procedures performed with the SurgiFile tool showed a statistically superior degree of decompression as compared with the standard surgical instruments and techniques.

A Comparison of the Degree of Lateral Recess and Foraminal Enlargement With Facet Preservation in the Treatment of Lumbar Stenosis With Standard Surgical Tools Versus a Novel Powered Filing Instrument: A Cadaver Study

AimInterspinous process device (IPD) placement is an attractive treatment option for lumbar spinal and foraminal stenosis. The goal of the treatment is to release the stress on facets joints as well as decompress the nerve roots by enlarging the intervertebral foramina and narrowed canal recesses.PurposeTo evaluate possible structural changes in the lumbar spine after implantation of an IPD on operated and adjacent segments.Patients and MethodsTwenty-two patients were enrolled in the study. Preoperative MRI scans of the lumbar spine evaluated recess and foraminal stenosis prior to the application of an IPD. CT exams were performed and morphometric measurements were made to assess the size of intervertebral foramina after implantation on the operated and adjacent segments.ResultsStatistically significant enlargements in diameter and surface area of the intervertebral foramen were seen at the operating level. On the right and left sides, foraminal enlargement after the procedure was 1 mm in diameter. The average enlargement of the foramina surface area at the level of implantation was 10 mm2. The median interspinous distance was significantly enlarged by 3.5 mm. No significant changes in adjacent segments were observed. Clinical improvement was confirmed by the Oswestry Disability Index (ODI) and visual analog scale (VAS). Preoperative disability was reduced (mean ODI from 70.5 (12.25) to 49.5 (23.75)), as well as back pain (mean VAS from 8.0 (1.7) to 4.4 (2.6)) and pain in lower limbs (mean VAS from 7.4 (1.9) to 3.8 (2.9)).ConclusionDecompression surgery using an IPD is effective in the treatment of lumbar foraminal and canal stenosis. It provides relief of symptoms in short-term observation through enlargement of intervertebral foramina and decompression of neural roots. It reduces overload of facet joints of the operated segment and does not decrease the size of the intervertebral foramina and disc heights of adjacent segments.

OBJECTIVE To conduct the first scoping review of lumbosacral neuroforaminal stenosis with respect to the pathophysiology, symptomatic manifestations, diagnostic imaging, and treatment options. METHODS A scoping literature review was conducted in accordance with the recommendations set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), with English language restrictions stipulated to include articles pertaining to lumbosacral neuroforaminal stenosis. Databases maintained by PubMed, National Library of Medicine, Cochrane Central Register of Controlled Trials (Ovid), Scopus (Elsevier), Web of Science (Thomson Reuters), and Google Scholar were queried from their inception date through December 2022. SUMMARY OF THE EVIDENCE A total of 276 articles were reviewed and 29 articles were included within the study. Within these articles, the anatomic origins of neuroforaminal stenosis were reviewed in detail and the resulting clinical manifestations were discussed. Recent studies evaluating the efficacy of existing diagnostic imaging modalities were summarized, along with potential future methods to improve sensitivity for detecting this entity and measuring foraminal stenosis via novel imaging techniques. Based on the literature, the conservative management and surgical treatment of lumbosacral foraminal stenosis were discussed. CONCLUSIONS Lumbar neuroforaminal stenosis represents a significant source of radicular pain that is often compounded by delayed diagnosis and incomplete treatment. This article represents the first scoping review of lumbosacral neuroforaminal stenosis with focus on diagnosis, management, and treatment for associated radicular pain. The goal is to reduce the incidence of untreated or unrecognized neuroforaminal stenosis in the setting of a complex decompression and fusion, as well as to promote minimally invasive surgery to address radicular pain from neuroforaminal stenosis. Recent advances in diagnostic imaging and surgical techniques have the potential to improve the timeliness and durability of patients’ treatment options. Future directions for the diagnostic imaging of foraminal stenosis include efforts aimed at developing the nascent field of computerized mapping to reliably quantify stenosis and its impact on the exiting nerve root and associated dorsal root ganglia.

Background/Objectives: Posterior endoscopic cervical foraminotomy is an established motion-preserving procedure for selected patients with unilateral cervical radiculopathy. However, isolated foraminal decompression may be insufficient in cases with concomitant foraminal stenosis and lateral soft disk herniation. This preliminary study evaluated clinical outcomes and quantitative MRI changes after combined posterior endoscopic cervical diskectomy and foraminotomy (CEDF) and explored the relationship between postoperative foraminal enlargement and clinical improvement. Methods: This retrospective single-center exploratory cohort study included 15 consecutive patients with single-level unilateral cervical radiculopathy caused by combined foraminal stenosis and lateral soft disc herniation who were treated between 2021 and 2023. All patients underwent CEDF using a posterior full-endoscopic approach. Clinical outcomes were assessed preoperatively, at 6 weeks, and at 12 months using the Visual Analog Scale for arm and neck pain, the Neck Disability Index, and modified MacNab criteria. Quantitative MRI assessment included minimal foraminal diameter, Foraminal Symmetry Index (FSI), and Quantitative Cervical Expansion (QCE). Correlations between radiological and clinical outcomes were analyzed as exploratory, hypothesis-generating analyses. Results: Mean minimal foraminal diameter increased from 1.9 ± 0.7 mm preoperatively to 4.1 ± 0.8 mm postoperatively, with improvement in FSI from 0.40 ± 0.12 to 0.89 ± 0.11. Significant clinical improvement was observed across all outcome measures. Mean arm pain decreased from 7.2 ± 1.3 preoperatively to 1.3 ± 1.4 at final follow-up, while NDI improved from 48.0 ± 14.0% to 18.3 ± 12.0%. The minimum clinically important difference for arm pain reduction was achieved in 14 of 15 patients. A moderate positive exploratory association was observed between foraminal enlargement and reduction in arm pain severity. No major neurological complications, postoperative instability, or revision procedures were observed in this small cohort during the available follow-up. Conclusions: In this preliminary retrospective single-center cohort, CEDF was associated with clinical improvement and measurable postoperative foraminal enlargement in carefully selected patients with unilateral cervical radiculopathy caused by combined foraminal stenosis and lateral soft disc herniation. The observed association between foraminal enlargement and arm pain reduction should be interpreted cautiously because of the small sample size and exploratory design. QCE and FSI should be regarded as preliminary quantitative radiological indices rather than validated markers of decompression adequacy or clinical response. Larger prospective comparative studies are required to validate these findings and define the role of CEDF among established cervical decompression procedures.

The objective of this study is to analyze incidence, estimate cost savings, and evaluate best management practices of complications resulting from outpatient transforaminal endoscopic decompression surgery for lumbar foraminal and lateral recess stenosis performed in an ambulatory surgery center. Endoscopic spinal surgery is gaining popularity for the treatment of lumbar disc herniations. Recent advances in surgical techniques allow for endoscopically assisted bony decompression for neurogenic claudication symptoms due to spinal stenosis. Postoperative complications from dural tears, recurrent disc herniations, nerve root injuries, foot drop, and facet and pedicle fractures, and postoperative sequelae such as dysesthetic leg pain and infiltration of the surgical access and spinal canal with irrigation fluid causing spinal headaches and painful wound swelling, as well as failure to cure, have been reported. A retrospective study of 1839 consecutive patients with an average mean follow up of 33 months (range: 24 to 85 months) that underwent transforaminal endoscopic decompression surgery at 2076 levels between 2006 and 2015 was conducted to analyze incidence, and estimate the cost savings of postoperative adverse events following endoscopic foraminotomy and microdiscectomy. Complications were stratified using Dindo's 7-category grading system, distinguishing them from procedure-inherent sequelae as well as failure to cure. Only patients with unilateral radiculopathy due to either herniated disc or lateral recess stenosis were included in this study. Preoperatively, disc migration was graded by direction and distance from the disc space according to Lee's radiologic 4-zone classification. The type of disc herniation was classified either as contained or extruded. Contained herniations were further subclassified as disc protrusions versus disc bulges. In addition, the preoperative disc height was recorded. Bony spinal foraminal stenosis and lateral recess stenosis were graded on preoperative magnetic resonance imaging and computed tomography scans into mild, moderate, and severe by dividing the lumbar neuroforamen into 3 zones: (1) entry zone, (2) midzone, and (3) exit zone. Surgical outcomes were classified according to the Macnab criteria. In addition, reduction in the visual analog scale (VAS) scores were assessed. According to the Macnab criteria, excellent and good results were obtained in 82.2% of patients with extruded disc fragment (331/1839). In this group, the mean VAS score decreased from 5.9 ± 2.5 preoperatively to 2.4 ± 1.8 at final follow-up (P < .01). Patients with contained disc herniations (648/1839) had excellent and good results 72.7% of the time. In this group, the mean VAS score decreased from 7.2 ± 1.6 preoperatively to 3.1 ± 1.5 at final follow-up (P < .01). In the spinal stenosis group (860/1839), 75% of patients had excellent to good results. Postoperative grade I complications (any deviation from normal postoperative course treated with observation) occurred in 2 patients who immediately developed foot drop postoperatively on the surgical side (0.11%) and in another 2 patients (0.11%) with incidental durotomy. Grade II complications (any deviation with pharmacological interventions) occurred in 11 patients due to chronic obstructive pulmonary disease exacerbation, and in another 2 patients due to infections as the latter were successfully treated with antibiotics. Grade IIIb complications (any deviation requiring surgical, endoscopic, or radiological intervention under general anesthesia) occurred in 9 patients with reherniations of extruded discs within the first 3 postoperative months (recurrence rate 2.7%). Reherniations were associated with preserved disc height of > 6 mm (P < .02). Grade IV (organ failure), and grade V (death) complications did not occur. Procedure-inherent sequelae from adverse operative side effects were noted in 8 patients with spinal headaches (0.44%), and in 69 patients (3.75%), who had extravasations of irrigation fluid into the subcutaneous tissues causing wound swelling. Another 229 patients developed postoperative dysesthetic leg pain due to irritation of the dorsal root ganglion (12.45%), which was associated with severe foraminal stenosis (P < .01) and improved with supportive care in all cases. Failure to cure occurred in 39 patients (2.12%) with bony stenosis in the central canal, and lateral recess involving the entry zone of the neuroforamen and in 41 patients (2.23%) with contained disc herniations. Complications after outpatient transforaminal endoscopic decompression surgery with respect to reherniation, wound infections, durotomy, and nerve root injury are approximately 1 magnitude lower than equivalent reported complication rates with microdiscectomy while delivering comparable clinical outcomes and lower readmission rates to an emergency room or hospital. Postoperative sequelae are typically self-limiting and successfully managed with supportive care measures. Significant cost savings are realized due to a considerably lower rate of decompensated postoperative medical problems.

The objective of this study was to analyze readmission rates after outpatient transforaminal endoscopic decompression surgery for lumbar foraminal and lateral recess stenosis done in an ambulatory surgery center. Endoscopic lumbar spinal surgery is gaining popularity for the treatment of lumbar disc herniations. Recent advances in surgical techniques allow for percutaneous endoscopically assisted bony decompression for neurogenic claudication symptoms due to spinal stenosis. The surgery can be done under local anesthesia and sedation. Patients may be discharged home within hours from surgery, and complications are rare. However, readmissions for recurrent disc herniations, failure of pain relief, dysesthetic leg pain, nerve root injuries with foot drop, and facet and pedicle fractures have been reported. A retrospective study of 1839 consecutive patients with an average mean follow up of 33 months (range 24 to 85 months) that underwent percutaneous endoscopic surgery at 2076 levels between 2006 and 2015 was conducted with the intent of identifying factors associated with emergency room or hospital readmission following endoscopic foraminotomy and microdiscectomy. Only patients with unilateral radiculopathy due to either herniated disc or lateral recess stenosis were included in this study. Preoperatively, disc migration was graded by direction and distance from the disc space according to Lee's radiologic 4-zone classification. The type of disc herniation was classified either as extruded or contained. Contained herniations were further subclassified as disc protrusions versus disc bulges. In addition, the preoperative disc height was recorded. Bony spinal foraminal stenosis and lateral recess stenosis were graded on preoperative magnetic resonance imaging and computed tomography scans into mild, moderate, and severe by dividing the lumbar neuroforamen into 3 zones: (a) entry zone, (b) midzone, and (c) exit zone. Surgical outcomes were classified according to the Macnab criteria. In addition, reduction in visual analog scores (VASs) were assessed. The treating physician (KUL) performed all surgeries. According to the Macnab criteria, excellent and good results were obtained in 82.2% of patients with extruded disc fragment (331/1839). In this group, the mean VAS decreased from 5.9 ± 2.5 preoperatively to 2.4 ± 1.8 at the final follow up (P < .01). Patients with contained disc herniations (648/1839) had excellent and good results 72.7% of the time. In this group, the mean VAS decreased from 7.2 ± 1.6 preoperatively to 3.1 ± 1.5 at the final follow up (P < .01). In the spinal stenosis group (860/1839), 75% of patients had excellent to good results. There were no major approach-related complications. Sixty-nine patients had extravasations of irrigation fluid into the subcutaneous tissues (3.8%). Eight patients developed spinal headaches (0.4%). Two patients developed foot drop on the surgical side immediately postoperatively (0.1%). Reherniations of extruded discs occurred in 9 patients (2.7% recurrence rate). Failure of pain relief without significant improvement of walking endurance occurred in 29 patients with bony stenosis in the central canal, lateral recess, and entry zone of the neuroforamen (3.3%). Reherniations were associated with preserved disc height of >6 mm (P < .02). Dysesthetic leg pain due to dorsal root ganglion irritation occurred in 229 patients (12.4%) and was unrelated to case frequency but was associated with severe foraminal stenosis (P < .01). All 229 patients improved with supportive care. Facet or pedicle fractures did not occur in this series. There were 26 acute care (within 6 weeks from surgery) postoperative emergency room visits [16 of which resulted in readmission to a hospital over the 9-year study period (0.86%): 9 for dysesthetic leg pain, 2 for wound infections, and 5 for poorly controlled incisional pain]. Transforaminal endoscopic decompression can be successfully carried out in an outpatient surgery center setting. Readmissions due to reherniations, postoperative complications, or poor pain control are uncommon.

Persistent lumbar foraminal stenosis (LFS) is one of the most common reasons for poor postoperative outcomes and is a major contributor to "failed back surgery syndrome." The authors describe a new surgical strategy for LFS based on anatomical considerations using 3D image fusion with MRI/CT analysis. A retrospective review was conducted on 78 consecutive patients surgically treated for LFS at the lumbosacral junction (2013-2017). The location and extent of stenosis, including the narrowest site and associated pathology (bone or soft tissue), were measured using 3D image fusion with MRI/CT. Stenosis was defined as medial intervertebral foraminal (MF; inner edge to pedicle center), lateral intervertebral foraminal (LF; pedicle center to outer edge), or extraforaminal (EF; outside the pedicle). Lumbar (low-back pain, leg pain) and patient satisfaction visual analog scale (VAS) scores and Japanese Orthopaedic Association (JOA) scores were evaluated. Surgical outcome was evaluated 2 years postoperatively. Most instances of stenosis existed outside the pedicle's center (94%), including LF (58%), EF (36%), and MF (6%). In all MF cases, stenosis resulted from soft-tissue structures. The narrowest stenosis sites were localized around the pedicle's outer border. The areas for sufficient nerve decompression were extended in MF+LF (10%), MF+LF+EF (14%), LF+EF (39%), LF (11%), and EF (26%). No iatrogenic pars interarticularis damage occurred. The JOA score was 14.9 ± 2.6 points preoperatively and 22.4 ± 3.5 points at 2 years postoperatively. The JOA recovery rate was 56.0% ± 18.6%. The VAS score (low-back and leg pain) was significantly improved 2 years postoperatively (p < 0.01). According to patients' self-assessment of the minimally invasive surgery, 62 (79.5%) chose "surgery met my expectations" at follow-up. Nine patients (11.5%) selected "I did not improve as much as I had hoped but I would undergo the same surgery for the same outcome." Most LFS existed outside the pedicle's center and was rarely noted in the pars region. The main regions of stenosis were localized to the pedicle's outer edge. Considering this anatomical distribution of LFS, the authors recommend that lateral fenestration should be the first priority for foraminal decompression. Other surgical options including foraminotomy, total facetectomy, and hemilaminectomy likely require more bone resections than LFS treatment. The microendoscopic surgery results were very good, indicating that this minimally invasive surgery was suitable for treating this disease.

Arthroscopy has evolved significantly with advancements in instrumentation and surgical techniques. The introduction of needle arthroscopy represents a promising minimally invasive alternative and, has for the wrist proven to offer a reduced soft tissue trauma with still maintained diagnostic and therapeutic efficacy. The purpose of this study was to evaluate the safety and visualization capabilities of needle arthroscopy of the elbow using cadaveric specimens. Six fresh-frozen cadaveric elbows (three right, three left) were examined using a needle arthroscope, followed by dissection to assess portal safety and proximity to neurovascular structures. The arthroscopic portals evaluated included the proximal anteromedial (PAMP), anteromedial (AMP), mid-anterolateral (MALP), postero-lateral (PLP), direct lateral, and direct posterior portals. The visualization quality of the needle arthroscope was found satisfactory and the smaller diameter (1.9 mm), allowed enhanced maneuverability. Needle arthroscopy offers improved access and acceptable visualization, potential risks remain, particularly concerning neurovascular structures. Notably, the anteromedial portal was in close proximity to the median nerve and medial antebrachial cutaneous nerve (MABCN), with one documented case of PBMACN (Posterior Branch of the MABCN) injury. Our results support the use of the needle arthroscope for elbow arthroscopy. However, caution is required to minimize neurovascular injury. Further studies are needed to establish standardized protocols and confirm the long-term safety and efficacy of needle arthroscopy in clinical practice.

Study Design: Retrospective cohort study. ObjectiveThis study compared the safety and efficacy of ultrasonic bone scalpel-assisted direct decompression versus conventional direct decompression (using high-speed drills and Kerrison rongeurs) in anterior cervical discectomy and fusion (ACDF) for cervical radiculopathy with foraminal bone stenosis. This retrospective cohort study included 94 patients who underwent cervical foraminal stenosis surgery from 2019 to 2022. Group A (n=48) received traditional direct decompression using a high-speed drill and Kerrison rongeur, while Group B (n=46) underwent direct decompression using a combination of drilling and ultrasonic bone scalpel. Clinical outcomes were assessed using Visual Analog Scale (VAS) for pain, Neck Disability Index (NDI) for functional disability, and smallest oblique sagittal area (SOSA) of the neural foramen on CT scans to evaluate foraminal enlargement.ResultsPatients in Group B demonstrated significantly greater improvements in VAS and NDI scores (p<0.01), with a larger mean SOSA (73.85 mm² vs 50.00 mm²) compared to Group A. Additionally, Group B showed a reduction in blood loss and shorter operative time. No significant differences in complication rates, including dural tears or nerve root injuries, were found between the two groups.ConclusionThe ultrasonic bone scalpel-assisted decompression technique offers significant advantages over traditional methods in terms of surgical outcomes, including better pain relief, functional recovery, and foraminal enlargement, while maintaining comparable safety profiles.

Patients with lumbosacral spinal stenosis (LSS) do not always obtain satisfactory pain relief from transforaminal epidural steroid injection (TFESI) because perineural/epidural adhesions prevent the spread of injectate into the epidural space. Percutaneous adhesiolysis (PA) can eliminate the deleterious effects of adhesion. This study was to evaluate the effectiveness of PA among patients with LSS refractory to TFESI and to ascertain the prognostic factors determining PA efficacy. Retrospective study. Spine hospital. Sixty-five patients with LSS refractory to TFESI who underwent PA with NaviCath® were reviewed. We recorded Numeric Rating Scale for back pain (NRS back) and leg pain (NRS leg), and Oswestry Disability Index (ODI), at pretreatment, 2 weeks, and 3 months after treatment. Successful pain relief and functional improvement were described as a 50% and 40% or more reduction in NRS and ODI, respectively. Clinical data and radiological findings were obtained to assess the possible predictive factors for PA efficacy. Among the 65 patients, 45 (69.2%), 40 (61.5%), and 39 (60.0%) patients showed successful outcomes in NRS back, NRS leg, and ODI at 2 weeks, respectively. Among 63 patients who were followed up at 3 months, 34 (54.0%), 32 (50.8%), and 30 (47.6%) patients showed successful results, respectively. Spondylolisthesis, previous lumbar surgery, and foraminal stenosis were associated with a significantly higher proportion of unsuccessful result in NRS and ODI (%). PA may be a useful treatment in patients with LSS refractory to TFESI and reduce the surgical requirement. Previous surgery, spondylolisthesis, and foraminal stenosis may be associated with poor prognosis.

New diagnostic support tool for lumbosacral foraminal stenosis using radiographs of the lumbar spine

A ten year-old intact male mongrel dog with black hair coat was referred to The National Taiwan University Veterinary Hospital (NTUVH) because of enlarged left eye with corneal edema. Following anti-glaucoma medical treatment and pharmacologic ablation of ciliary body with failure, the eye with end-stage glaucoma was enucleated. An uveal melanoma with malignant features was diagnosed at surgery and pathological examination. Four months after surgery, subcutaneous masses on its back and gingiva were noted. Radiographic examination revealed a huge mass, with increased density in hilus of the lung. Laparotomy and masses excision from the abdomen was performed. The malignant melanoma with widespread metastasis was diagnosed following pathological results of the masses. The gingival mass recurred one month after surgery and the owner decided euthanasia of the dog.

Patient-reported outcome measures (PROMs) have become widely used to better measure patients' judgment of treatment benefits from surgical spine care. The concept of determining the minimal clinically important differences (MCIDs) of PROMs is aimed at assessing the benefits of lumbar spine care that are meaningful to the patient. The goal of this study was to validate the utility of MCIDs of the visual analog score (VAS) and Oswestry Disability Index (ODI) in patients with sciatica-type low back and leg pain due to lateral recess and foraminal stenosis who were treated with directly visualized transforaminal outpatient endoscopic decompression. The retrospective study population consisted of 406 patients on whom PROMs were obtained preoperatively, and again postoperatively at final follow-up. Employing an anchor-based approach with a patient satisfaction index based on the modified Macnab criteria, a receiver operating characteristics (ROC) and area under the curve (AUC) analysis was performed using IBM SPSS 25.0 to define the optimal MCID in VAS and ODI with the transforaminal endoscopy using the top-left-corner criteria and the Youden index. Improvements in walking endurance were recorded as an additional parameter of patient functioning and correlated with PROMs to test for statistical significance. The patients' average age was 41.08 years, ranging from 30 to 84 years. The mean follow-up was 33.59 months, ranging from 24 to 85 months, with a standard deviation of 12.79. The MCIDs for VAS and ODI were 2.5 to 3.5 and 15 to 16.5, respectively. Patients were dichotomized as improved (377/406; 92.9%) if they reported excellent (224/406; 55.2%), good (112/406; 27.6%), and fair (41/406; 10.1%) Macnab outcomes. Patients were dichotomized as failed if they reported poor (29/406; 7.1%) Macnab outcomes. Preoperatively, only 32.5% (132/406) of patients had unlimited walking endurance compared to 77.6% (315/406) of patients postoperatively. The ROC and AUC analysis showed better accuracy with the single-integer VAS score (0.926) than with the 10-item ODI score (0.751). Transforaminal outpatient endoscopic decompression for symptomatic foraminal and lateral recess stenosis is an effective surgical treatment to alleviate sciatica-type and back symptoms in 92.9% of patients. Of the PROMs analyzed, the VAS provided a more meaningful and accurate reflection of patients' interpretation of outcome with the transforaminal endoscopic spinal decompression procedure than ODI. Understanding which patient expectations drive these MCIDs may aid in replacing open surgeries for sciatica-type low back and leg pain currently preferred by traditional spine surgeons with a personalized early-staged transforaminal endoscopic hybrid decompressive/ablative procedures favored by the authors. These may prove more cost effective by focusing on significant pain generators validated with a diagnostic interventional workup instead of employing image-based indication criteria for surgery.