Transforaminal Endoscopic Decompression for Painful Degenerative Conditions of The Lumbar Spine: A review of One Surgeon’s Experience with Over 10,000 Cases Since 1991

Abstract

Background: Endoscopic Spine Surgery has evolved rapidly in the past 5 years, and is getting less pushback by traditional spine surgeons who have no exposure or training in endoscopic spine surgery in their training. The author has dedicated his last 25 years to transforaminal endoscopic surgery. He has previously reported on his 12 years’ experience in 2007 in IJAS Surgery, but 13 years later, continued evolution of the transforaminal approach aided by new endoscopes and endoscopic instrumentation has allowed the author and experienced endoscopic surgeons adopting this approach, with the ability to treat 90 percent of painful degenerative conditions of the lumbar spine after the learning curve is conquered. Methods: Three different methods have evolved. Yeung’s “insideout” philosophy and technique, Hoogland’s “outside in” philosophy technique, and a hybrid targeted technique combining inside out and outside in, that depends on targeting the patho-anatomy. This paper reviews Yeung’s philosophy and technique backed by over 10,000 procedures in the past 25 years Results: After a learning curve for each pathology targeted, an overall 90% good to excellent success rate measured by VAS, Oswestry, patient satisfaction, and minimal minor complications of less than 3 percent can be achieved. A detailed review of Yeung’s experience supplements his 12 year report in the International Journal of Spine Surgery in 2007. Conclusion: The transforaminal endoscopic technique has evolved to be the least invasive, most effective method to surgically address the pain generators in the lumbar spine. The technique allows for earlier treatment of painful conditions that fail nonsurgical treatment. This monograph can be used as a guide for new surgeons who want to treat patients with “surgical pain management” that incorporates pain management with surgical treatment that will help decrease the escalating cost of spine care all over the world.