To evaluate the value of three-dimensional visualization preoperative planning based on the open-source software 3D Slicer in endoscopic endonasal optic nerve decompression for traumatic optic neuropathy. A prospective randomized controlled study was conducted. A total of 48 patients with traumatic optic neuropathy who underwent endoscopic endonasal optic nerve decompression at the Affiliated Eye Hospital of Nanchang University between January 2023 and June 2025 were enrolled and randomly assigned to an experimental group (3D Slicer-based three-dimensional visualization planning, n = 25) and a control group (conventional two-dimensional CT planning, n = 23). The primary outcome measures included operative time, intraoperative misjudgment rate, complication rate, surgeon's subjective score (5-point Likert scale), and visual improvement at 3 months postoperatively. Continuous data were analyzed using independent-sample t-test or Mann-Whitney U test, and categorical data were analyzed using Fisher's exact test. There were no statistically significant differences in baseline characteristics or preoperative visual acuity grade between the two groups (P > 0.05). The operative time was significantly shorter in the experimental group than in the control group (129.4 ± 11.6min vs. 150.7 ± 20.4min, P < 0.001). Postoperative visual acuity improved significantly compared with preoperative values in both groups (experimental group: P < 0.001; control group: P = 0.003), but the intergroup difference in the grade of visual improvement was not statistically significant (P = 0.439). The intraoperative misjudgment rate was 0% (0/25) in the experimental group and 13.0% (3/23) in the control group, with no statistically significant difference (P = 0.24). The incidence of cerebrospinal fluid leakage was 4.0% (1/25) in the experimental group and 21.7% (5/23) in the control group, and the difference did not reach statistical significance (P = 0.08). The surgeon's subjective score was significantly higher in the experimental group than in the control group [5 (5,5) vs. 4 (4,4), P < 0.001]. No severe complications such as major vessel injury or direct optic nerve injury occurred in either group. Three-dimensional visualization preoperative planning based on 3D Slicer can significantly shorten the operative time of endoscopic endonasal optic nerve decompression, enhance the surgeon's confidence, and a potential reduction in cerebrospinal fluid leakage that warrants further investigation. This approach is low-cost, highly generalizable, and has good clinical application value.

Persistent pain after total hip arthroplasty (THA) is a common complication requiring extensive diagnostic effort and is often associated with potentially invasive and morbid treatment options. With THA volume expected to steadily increase there is a similarly growing need for creative and effective diagnostic and therapeutic options for these clinically challenging patients. Hip arthroscopy has emerged as a promising tool in the setting of persistent pain after THA with expanding indications and promising outcomes. The purpose of this article was to provide a review of the current state of literature regarding arthroscopic and endoscopic solutions for common causes of persistent pain after THA with a focus on patient selection, indications, surgical considerations, outcomes, and complications. The most common indication for hip arthroscopy after THA is iliopsoas tendinopathy, showing excellent outcomes with symptom resolution in greater than 90% of patients after arthroscopic iliopsoas release or lengthening. The second most common indication is diagnostic arthroscopy in the setting of otherwise negative extensive work-up, which has shown diagnostic value for occult implant loosening, capsular fibrosis, and metal hypersensitivity. Endoscopic decompression for the treatment of ischiofemoral impingement and sciatic nerve decompression has also shown consistent improvements in pain and function. In addition to these well described indications, future utilization of hip arthroscopy for loose body removal, capsular plication for instability, and management of prosthetic joint infection are potentially emerging indications. Hip arthroscopy after THA is a safe and effective tool for the management of common causes of persistent pain after THA with robust support for iliopsoas pathology and emerging evidence and outcomes for less common indications. Future research will both expand and narrow these indications as diagnostic criteria, patient selection, and surgical techniques are refined.

Study DesignProspective observational pilot study.ObjectivesIntroducing endoscopic spine surgery in low- and middle-income countries (LMICs) poses logistical and clinical challenges, yet offers potential patient benefits. This study describes the implementation of a pilot endoscopic spine surgery program in Tanzania and reports early outcomes from the first patient cohort.MethodsWeill Cornell Medicine and the University of California, Irvine facilitated the introduction of endoscopic spine surgery techniques in Tanzania through theoretical and hands-on training, equipment donations, and live surgical mentorship. Fourteen patients with lumbar pathology refractory to conservative treatment underwent endoscopic microdiscectomy and/or decompression. Outcomes were assessed using the Oswestry Disability Index (ODI) and the Visual Analog Scale (VAS) for back and leg pain, measured preoperatively and postoperatively up to 3months. All fourteen patients (100%) completed the 3-month assessment.ResultsA structured 5-day program integrating didactic instruction, simulation-based training, and supervised live surgeries successfully introduced spine endoscopy in Tanzania. Fourteen patients underwent endoscopic lumbar decompression (FESS n = 8; UBE n = 6). At short-term follow-up, marked early reductions were observed in back-pain VAS (P < 0.001, Kendall's W = 0.53), leg-pain VAS (P < 0.001, W = 0.59), and ODI (P < 0.001, W = 0.79). All preoperative-versus-postoperative pairwise comparisons survived Benjamini-Hochberg false-discovery-rate adjustment (q = 0.05). These results reflect feasibility and early safety only and should not be interpreted as evidence of sustained benefit or comparative effectiveness.ConclusionThis pilot study demonstrates the successful implementation of endoscopic spine surgery in an LMIC setting through structured international collaboration. The clinical outcomes reported are short-term and observed under selected pilot conditions; larger studies with longer follow-up are needed to evaluate durability, comparative effectiveness, and external validity.

Transforaminal endoscopic lumbar decompression (TELD) has emerged as a minimally invasive treatment for lumbar lateral recess stenosis (LRS). However, long-term outcomes in patients with chronic systemic disease remain insufficiently characterized. To evaluate the clinical outcomes and safety of TELD in patients with chronic systemic disease undergoing surgery for symptomatic single-level lumbar LRS. This retrospective observational study included patients with chronic systemic disease who underwent TELD with reamed foraminoplasty for symptomatic single-level lumbar LRS at a single tertiary spine center between January 2016 and March 2021. Clinical outcomes were assessed using visual analog scale (VAS) scores for leg and back pain, the Oswestry Disability Index, and modified MacNab criteria. Follow-up was conducted for 60 months. Early complications (≤30 days) and reoperations were recorded. A total of 67 patients (mean age 59 ± 11.4 years) were available for 5-year follow-up. Mean operative time was 41 ± 8 minutes. VAS leg pain improved from 7.8 ± 1.3 preoperatively to 1.8 ± 0.8 at 60 months (P < 0.001), VAS back pain improved from 4.3 ± 0.9 to 2.0 ± 1.0 (P < 0.001), and Oswestry Disability Index improved from 57.0 ± 12.5 to 16.4 ± 8.7 (P < 0.001). According to the modified MacNab criteria, 85.1% of patients achieved excellent or good outcomes. Early complications occurred in 3 patients (4.5%), all consisting of transient postoperative dysesthesia, while late reoperation was required in 4 patients (6.0%). TELD resulted in significant and durable improvements in pain and functional disability over a 5-year follow-up period in patients with chronic systemic disease. These findings support TELD as a safe and effective minimally invasive treatment option for carefully selected patients with chronic systemic disease and lumbar LRS. This study highlights TELD as a viable minimally invasive treatment option for patients with chronic systemic disease, offering durable symptom relief in a carefully selected cohort.

Dysthyroid optic neuropathy (DON) is occasionally resistant to corticosteroid treatment. In these cases, emergent transnasal endoscopic orbital decompression may be the optimal therapy method. We evaluated 13 patients with steroid-resistant DON to determine the potential benefit of this surgical intervention. Thirteen patients with steroid-resistant DON seen at Shenzhen Eye Hospital (China) between January 2023 and April 2025 were included in our study. All patients underwent emergent transnasal endoscopic orbital decompression and received postoperative corticosteroids and neurotrophic medication. The rate of improvement in postoperative best-corrected visual acuity (BCVA) was an important criterion for successful postoperative therapy. In all, 13 patients (range, 34-72y) with 13 eyes (8 right eyes and 5 left eyes) were included in our study. The duration of DON ranged from 9 to 36 months (median time 17.4mo). Eleven of 13 patients (84.61%) had a statistically significant improvement in BCVA from 0.76±0.28 LogMAR to 0.23±0.18 postoperatively ( P <0.01). These 11 patients underwent decompression within <26 months of diagnosis. Three of these 11 patients demonstrated pronounced BCVA improvement: 2 of them improved from counting fingers to 0.6 and 0.02, respectively, and the other improved from hand motion to 0.3. However, the remaining 2 showed no improvement. Emergent transnasal endoscopic orbital decompression surgery is a very useful and effective treatment for dysthyroid optic neuropathy (DON) that is refractory to corticosteroid therapy. Its efficacy seems inversely correlated with disease duration rather than preoperative BCVA. As such, longer disease duration may be associated with poorer postoperative outcomes.

Nonarteritic anterior ischemic optic neuropathy (NAION) remains a major cause of blindness with no consensus on treatment. The heterogeneity of patient outcomes suggests that a "one-size-fits-all" approach is ineffective. This study aimed to identify structural biomarkers to define the therapeutic window for endoscopic transnasal optic canal decompression (ETOCD) and explore its mechanism via vascular reperfusion imaging. Seventy-one patients diagnosed with NAION were included and categorized into two groups: an ETOCD group (n = 30) and a medical management group (n = 41). Best-corrected visual acuity (BCVA), visual field index (VFI), mean deviation (MD), pattern standard deviation (PSD), and retinal nerve fiber layer (RNFL) thickness were assessed at baseline and 3 months after treatment. Optical coherence tomography angiography (OCTA) was utilized to evaluate microvascular recovery. Multivariable regression and interaction analyses were performed to investigate RNFL as a predictive biomarker. While ETOCD showed superior overall efficacy (Adjusted β = -0.41, P < 0.001), a critical treatment-by-biomarker interaction was identified (P for interaction = 0.014). Patients with moderate edema (RNFL < 150μm) exhibited a profound therapeutic response (OR 7.88, 95% CI: 2.07-29.94, P = 0.002), whereas those with massive edema derived minimal benefit. OCTA analysis in responders revealed significant radial peripapillary capillary reperfusion, providing mechanistic support of the "osseous compartment syndrome" hypothesis. We identified baseline RNFL thickness (< 150μm) as a potential predictive biomarker for surgical success in NAION. These findings support an alternative therapeutic strategy from empiric treatment to biomarker-guided precision decompression, bridging the gap between anatomical pathology and surgical intervention. Retrospectively registered.

To comprehensively evaluate the clinical efficacy, surgical invasiveness, learning curve, and biomechanical characteristics between endoscopic posterior cervical canal decompression (Endo-PCCD) and laminoplasty (LP) in patients with two-level cervical spondylotic myelopathy (CSM). This study uniquely integrates clinical outcomes, cumulative sum (CUSUM) learning curve analysis, and finite element modeling to provide a multidimensional comparison between the two procedures. This retrospective study included 95 patients with CSM, of whom 45 underwent Endo-PCCD and 50 underwent LP. Baseline characteristics, perioperative parameters, and clinical outcomes (VAS, JOA, and NDI) were compared. DSA improvement rates were measured at C3-C5, C4-C6, and C5-C7 levels. Learning curves were assessed based on cumulative sum (CUSUM) analysis. Cervical finite element models were developed to evaluate the segmental range of motion (ROM) of Endo-PCCD and LP under identical loading conditions. Baseline characteristics were comparable between groups. The Endo-PCCD group showed significantly shorter operative time, lower drainage volume, and higher postoperative hemoglobin (Hb) levels (all P < 0.05). Clinical outcomes were similar at all follow-up time points. DSA improvement was significantly greater in the LP group at C5-C7 (P < 0.001), with no differences at other levels. Proficiency thresholds were 25 cases for Endo-PCCD and 19 cases for LP. Finite element analysis indicated that the LP model exhibited increased segmental ROM under flexion and extension, whereas the Endo-PCCD model maintained motion patterns closer to the intact spine. Endo-PCCD achieves clinical outcomes comparable to LP while offering a potential trend toward reduced surgical invasiveness and may better preserve physiological cervical biomechanics, although LP may provide greater decompression at certain levels. Clinical trial number Not applicable.

This study aimed to comprehensively evaluate the efficacy and safety of personalized multimodal orbital decompression for thyroid-associated orbitopathy (TAO) via large-scale retrospective analysis, and to optimize surgical strategies accordingly. A retrospective cohort study included 199 TAO patients (263 eyes) who underwent orbital decompression between September 2021 and June 2025. Patients were stratified into four groups by surgical modality: transconjunctival fat decompression, endoscopic transnasal medial wall decompression, combined transconjunctival medial-lateral wall decompression, and combined endoscopic transnasal medial-lateral wall decompression. Primary outcomes were changes in LogMAR best-corrected visual acuity (BCVA), proptosis, and intraocular pressure (IOP); secondary outcomes included ocular motility, diplopia, and postoperative complication rates. All surgical strategies resulted in significant clinical improvements. Overall mean proptosis was reduced from 21.16 ± 2.75mm to 15.01 ± 1.86mm (p < 0.0001). Mean BCVA improved from 0.67 ± 0.68 LogMAR to 0.34 ± 0.42 LogMAR (p < 0.0001), with the most significant improvement seen in patients with preoperative Dysthyroid Optic Neuropathy (DON). DON was present in 46.4% of eyes, with the highest prevalence in Groups 2 (76.6%) and 4 (62.2%). Combined bony wall decompression (Groups 3 & 4) yielded the greatest proptosis reduction (7.67mm and 7.29mm, respectively), significantly more than single-modality decompression (p < 0.0001). The overall complication rate was 9.1%, with new-onset or worsening diplopia being the most common, but often transient or successfully managed with subsequent strabismus surgery. Endoscopic medial wall decompression (Group 2) was associated with the lowest complication rate (4.3%). In this large single-centre retrospective cohort, individualized orbital decompression was associated with significant improvements in proptosis, visual function, IOP, ocular motility, and diplopia-related outcomes in patients with TAO. Combined medial-lateral wall decompression achieved greater proptosis reduction, whereas procedures involving medial wall decompression were associated with visual improvement in eyes with DON. These findings support an indication-driven approach to surgical selection, while the retrospective design, baseline differences among groups, and eye-level analysis should be considered when interpreting comparative results.

Abstract Extradural posterior fossa decompression is widely used in symptomatic Chiari I malformation. Minimally invasive endoscopic approaches aim to reduce surgical morbidity while preserving decompression efficacy. The objective of this study is to compare operative efficiency and perioperative morbidity between endoscopic and conventional microsurgical extradural decompression techniques over an extended institutional experience. A retrospective comparative study of 25 consecutive adult patients undergoing extradural posterior fossa decompression for Chiari I malformation over an 8-year period was performed. Patients were divided into an endoscopic group (n = 13) and a microsurgical group (n = 12). Operative time, estimated blood loss, hospital stay, and perioperative complications were analyzed. The present cohort represents an extension of a previously published pilot series with additional patients and expanded perioperative evaluation. Mean operative time was comparable between endoscopic and microsurgical techniques (65 vs. 64 minutes). Estimated blood loss was lower in the endoscopic group (110 mL) compared with the microsurgical group (180 mL), representing a 39% reduction. Mean hospital stay was shorter in the endoscopic group (1.75 days) versus the microsurgical group (2.67 days). No cerebrospinal fluid leakage, reoperation, or neurological deterioration occurred in either group. Delayed wound healing was more frequent in the microsurgical group, whereas one case of delayed occipital neuralgia was observed in the endoscopic group. Endoscopic extradural decompression provides operative efficiency equivalent to the microsurgical approach while reducing intraoperative blood loss and shortening hospitalization. Technical refinement and standardization appear critical in optimizing surgical morbidity without compromising decompression safety.

Vertebrobasilar dolichoectasia (VBDE) is an uncommon cause of trigeminal neuralgia (TN), in which an ectatic vertebral artery (VA) compresses the root entry zone (REZ), while perforators may limit safe transposition. Fully endoscopic microvascular decompression with VA transposition was performed. Preservation of all arterial branches was achieved and confirmed endoscopically. In VBDE-related TN, VA transposition may be the preferred decompressive strategy because of the characteristics of the ectatic vessel. Endoscopy offers a wide-angle view of the REZ, facilitating safe mobilization under full visualization of branch vessels.

Comparative Effectiveness and Safety of Unilateral Hemilaminectomy, Unilateral Biportal Endoscopic Decompression, and Percutaneous Transforaminal Endoscopic Surgery for Lumbar Degenerative Disease: A Systematic Review and Meta-Analysis with Pathology-Stratified Exploratory Subgroup Analyses.

Bilateral endonasal endoscopic optic nerve decompression in a 7-month-old male patient with osteopetrosis: A case report with review of the literature

Analysis of risk factors for deep vein thrombosis after lumbar endoscopic single-segment decompression without fusion.

Early clinical outcomes of simultaneous biportal endoscopic decompression for tandem spinal stenosis: a single-center retrospective study

Two widely used full-endoscopic lumbar interbody fusion (FE-LIF) techniques include the facet-preserving trans-Kambin approach, performed via a transforaminal corridor, and the facet-sacrificing endoscopic posterolateral transforaminal lumbar interbody fusion, which utilizes an interlaminar route. More recently, several authors have introduced an emerging transfacet endoscopic approach as an alternative, minimally invasive strategy for LIF. However, the majority of these studies have relied on direct decompression of neural elements, and the effectiveness of indirect decompression following transfacet endoscopic fusion has not yet been established. This study describes a keyhole transfacet FE-LIF technique that employs indirect decompression to decompress neural elements. A limited facetectomy is performed using an endoscopic round burr to create a keyhole transfacet osseous corridor, allowing disc removal, endplate preparation, and interbody cage insertion without direct visualization or manipulation of the exiting or traversing nerve roots. When necessary, supplemental endoscopic direct decompression can be performed following cage placement in the same setting. This study highlights the cases of 4 patients with diverse degenerative lumbar spine pathologies: low-grade degenerative spondylolisthesis, low-grade isthmic spondylolisthesis with severely collapsed disc space, segmental coronal lumbar deformity with severe spinal canal stenosis, and pseudarthrosis following prior lumbar interbody fusion surgery. All patients underwent keyhole transfacet FE-LIF with an indirect decompression technique and had a minimum follow-up of 1 year. This study describes the surgical technique for indirect decompression performed in a prone position using keyhole transfacet endoscopic fusion, presents early clinical application, and reports short-term radiographic observation associated with this technique. The keyhole transfacet endoscopic fusion offers a minimally invasive approach for achieving indirect decompression in the prone position in patients with various lumbar degenerative spinal conditions. In addition, adjunctive direct decompression can be performed in the same setting after cage insertion when indicated.

Establishing navigated UBE in Europe \u2013 technical note

Clear intraoperative visualization is essential for safe and effective endoscopic spine surgery, yet existing assessments remain subjective and lack standardization. The Visualization in Endoscopic Workspace (VIEW) Score was developed to provide an objective, reproducible grading system for evaluating intraoperative visualization quality. This study aimed to validate the VIEW Score as a standardized and reliable tool for assessing visualization during endoscopic spine surgery. The VIEW Score is a 4-point ordinal scale (0 = Excellent, defined as no bleeding observed, to 3 = Poor) developed through expert consensus to evaluate bleeding, clarity of anatomical structures, and impact on surgical progress. Five experienced endoscopic spine surgeons independently rated 40 de-identified, 5-second video clips of interlaminar endoscopic lumbar spine surgery. After a 4-week washout period, the raters re-evaluated the same clips in a randomized order. Inter- and intra-rater reliability were analyzed using the Intraclass Correlation Coefficient (ICC) with a two-way random effects model for absolute agreement. The VIEW Score demonstrated excellent inter-rater reliability for mean ratings (ICC(2,5) = 0.963; 95% CI 0.940-0.979) and good single-rater reliability (ICC(2,1) = 0.839; 95% CI 0.758-0.902). Intra-rater reliability was also high (mean ICC 0.889 ± 0.04; range 0.840-0.943). Reliability remained consistently strong across approach (ICC(2,5) = 0.965) and decompression phases (ICC(2,5) = 0.945). The VIEW Score is a reliable and objective grading system for assessing intraoperative visualization during endoscopic lumbar decompression. Its strong reproducibility supports its use for standardized communication, surgical training evaluation, quality assessment, and future research examining visualization, hemostasis, and surgical workflow.

To report a rare case of cervical Tarlov cyst successfully treated using a percutaneous uniaxial endoscopic fenestration. This was a single case report describing the surgical technique, clinical assessment, radiological verification, and long-term follow-up outcomes of percutaneous uniaxial endoscopic surgery for symptomatic cervical Tarlov cyst. A 43-year-old male patient presented with intermittent pain and numbness in his right forearm for 2 years, with exacerbation over the past month. The symptoms were aggravated by fatigue and upon waking in the morning, and conservative treatment yielded no effect. MRI revealed a C8 Tarlov cyst. The patient underwent cervical percutaneous endoscopic laminar decompression and Tarlov cyst resection. Cervical MRI performed on the 2nd postoperative day confirmed complete cyst resection. Postoperatively, the patient's radicular pain almost completely resolved without symptoms of cerebrospinal fluid leakage, and no recurrence of pain was reported during a 2-year follow-up. This case report describes the safe and successful application of percutaneous uniaxial endoscopic fenestration combined with cervical Tarlov cyst resection.

Varied surgical alternatives for treating cubital tunnel syndromes have been used. A trend of endoscopic ulnar nerve release is emerging. The purpose of this study is to introduce a modified technique of endoscopic ulnar nerve decompression in association with anterior transposition of the ulnar nerve and to assess the feasibility and efficacy of the surgery. We introduced a modified method of endoscopic release and subfascial anterior transposition of the ulnar nerve. The technique was applied to six patients who presented signs, symptoms, and abnormal neurophysiological studies of cubital tunnel syndrome. The patients were classified according to the Dellon classification preoperatively. The Bishop rating system was used to evaluate the postoperative outcomes. Trial registration number for the study is MR-31-25-090620. Preoperatively, all six patients were classified as severe according to the Dellon classification. The endoscopic cubital tunnel release and subfascial anterior ulnar nerve transposition surgeries were performed with no difficulty in all patients. All the patients had improvement in symptoms and scored excellent or good according to the modified Bishop Rating System postoperatively. The modified endoscopic cubital tunnel release and subfascial anterior ulnar nerve transposition technique is technically feasible with satisfactory outcomes in six patients in this study.

Transforaminal endoscopic lumbar decompression (TELD) has emerged as a minimally invasive alternative for managing lumbar stenosis and disc herniations. While the literature consistently reports favorable outcomes, real-world adoption remains variable, with discrepancies often linked to surgeon experience and case complexity. To evaluate surgeon perspectives on the clinical applicability of TELD across different pathologies and compare these findings with published evidence. An international cross-sectional survey was conducted among spine surgeons. Responses were analyzed using Rasch modeling to assess consensus levels, with agreement categorized as strong, moderate, weak, or disagreement. Differential Item Functioning (DIF) and correlation analyses were applied to identify potential bias between neurosurgeons and orthopedic surgeons and to explore associations between pathologies. Analysis of 128 surgeon responses demonstrated clear stratification of consensus across pathologies. Strong agreement was observed for posterolateral herniated nucleus pulposus (HNP), far-migrated HNP, and lateral canal stenosis, reflecting consistent confidence in the applicability of TELD for these conditions. Moderate consensus was found for central HNP and central canal stenosis, where responses were stable but showed slightly greater variability. In contrast, low agreement was reported for lumbar facet cysts and low-grade spondylolisthesis, underscoring areas of ongoing controversy and divergent practice patterns. The Q3 correlation matrix revealed both overlapping and divergent domains of surgical confidence. Positive correlations linked lateral canal and central canal stenosis (r = 0.116), suggesting that surgeons proficient in transforaminal approaches for lateral pathology may also extend these skills to central disease. Similarly, lumbar facet cysts and low-grade spondylolisthesis showed a modest positive relationship (r = 0.073), consistent with their frequent clinical copresentation. Conversely, negative correlations highlighted distinct areas of expertise. For example, central canal stenosis and posterolateral HNP demonstrated a strong negative association (r = -0.475), while far-migrated HNP correlated negatively with both facet cysts (r = -0.348) and low-grade spondylolisthesis (r = -0.317). These findings suggest that technical proficiency in 1 domain does not necessarily translate to others, emphasizing the need for specialized training in complex or atypical scenarios. Refinement in training and technique positions transforaminal endoscopic surgery to redefine spinal stenosis care, moving past the entrenched notion that its use is confined to foraminal and lateral canal disease while central canal pathology belongs exclusively to interlaminar methods. This study signals a shift away from the rigid notion that transforaminal endoscopy is limited to compressive painful pathology in the lateral canal while interlaminar approaches are preferable for central stenosis. In expert hands, modern endoscopic techniques demonstrate that low-risk transforaminal decompression can be successfully applied to more complex conditions, including central stenosis with or without low-grade spondylolisthesis. These findings emphasize the importance of advanced training programs to enable practicing spine surgeons to achieve outcomes comparable to those reported by key opinion leaders. Psychometrically validated, high-quality observational survey study (see also Authors' Note).