Kim Chi-Ho, Kim Pius, Ju Chang-Il, Seo Jong-Hun
Department of Neurosurgery, College of Medicine, Chosun University, Gwangju 61453, Republic of Korea.
Diagnostics (Basel). 2025 May 21;15(10):1299. doi: 10.3390/diagnostics15101299.
One of the surgical treatments for lumbar foraminal stenosis, full endoscopic foraminotomy, is known for its numerous advantages and favourable clinical outcomes. While previous studies have analyzed preoperative radiological risk factors associated with recurrence within one year after endoscopic foraminal decompression, no research has investigated postoperative radiological changes. The aim of this study is to analyze the radiological changes occurring in cases of early recurrence within six months after endoscopic foraminal decompression. : A retrospective review was conducted on patients with unilateral lumbar foraminal stenosis who underwent full endoscopic foraminotomy at a single institution. The study included 11 recurrent patients who initially experienced symptomatic improvement and sufficient neural decompression on radiological evaluation, but exhibited recurrent radicular pain and radiological restenosis within six months postoperatively. Additionally, 33 control patients with favourable clinical outcomes and no evidence of restenosis were analyzed. Preoperative and postoperative plain X-ray imaging was used to evaluate sagittal and coronal parameters reflecting spinal anatomical characteristics, including disc height, foraminal height, disc wedging, coronal Cobb's angle, total lumbar lordosis angle, segmental lumbar lordosis angle, and dynamic segmental lumbar lordosis angle. The study aimed to analyze postoperative changes in these parameters between the recurrent and control groups. Clinical outcomes were assessed using the Visual Analog Scale (VAS). There were no significant differences between the groups in terms of age, sex distribution, presence of adjacent segment disease, or existence of Grade 1 spondylolisthesis. Analysis of preoperative and postoperative radiological changes revealed that, in the recurrent group, disc height and foraminal height showed a significant decrease postoperatively, while disc wedging and the coronal Cobb's angle demonstrated a significant increase. In contrast, the control group exhibited a significant postoperative increase in the total lumbar lordosis angle and segmental lumbar lordosis angle. : Progressive worsening of disc wedging and the coronal Cobb's angle, and reductions in disc and foraminal height, along with minimal improvement in lumbar lordosis following TELF, suggest the presence of irreversible preoperative degenerative changes. Careful radiologic assessment and close postoperative monitoring are essential to identify patients at risk of early recurrence.
腰椎椎间孔狭窄的手术治疗方法之一，全内镜下椎间孔切开术，以其众多优点和良好的临床效果而闻名。虽然先前的研究分析了内镜下椎间孔减压术后一年内复发相关的术前放射学危险因素，但尚无研究调查术后的放射学变化。本研究的目的是分析内镜下椎间孔减压术后六个月内早期复发病例的放射学变化。：对在单一机构接受全内镜下椎间孔切开术的单侧腰椎椎间孔狭窄患者进行了回顾性研究。该研究纳入了11例复发患者，这些患者最初在放射学评估中症状改善且神经减压充分，但术后六个月内出现复发性神经根性疼痛和放射学再狭窄。此外，分析了33例临床效果良好且无再狭窄证据的对照患者。术前和术后的X线平片成像用于评估反映脊柱解剖特征的矢状面和冠状面参数，包括椎间盘高度、椎间孔高度、椎间盘楔形变、冠状面Cobb角、腰椎总前凸角、节段性腰椎前凸角和动态节段性腰椎前凸角。该研究旨在分析复发组和对照组之间这些参数的术后变化。使用视觉模拟量表（VAS）评估临床效果。两组在年龄、性别分布、相邻节段疾病的存在或I度椎体滑脱的存在方面无显著差异。术前和术后放射学变化分析显示，在复发组中，术后椎间盘高度和椎间孔高度显著降低，而椎间盘楔形变和冠状面Cobb角显著增加。相比之下，对照组术后腰椎总前凸角和节段性腰椎前凸角显著增加。：椎间盘楔形变和冠状面Cobb角的逐渐恶化，以及椎间盘和椎间孔高度的降低，以及全内镜下腰椎椎间孔切开术后腰椎前凸改善极小，提示术前存在不可逆的退行性改变。仔细的放射学评估和密切的术后监测对于识别早期复发风险患者至关重要。
