Ahn Yong, Park Han-Byeol, Son Seong, Yoo Byung-Rhae
Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul 05278, Republic of Korea.
Department of Neurosurgery, Gachon University Gil Medical Center, Incheon 21565, Republic of Korea.
J Clin Med. 2025 Sep 12;14(18):6446. doi: 10.3390/jcm14186446.
: Transforaminal endoscopic lumbar foraminotomy (TELF) is an emerging minimally invasive surgical technique for lumbar foraminal stenosis. However, its effectiveness is debated because of concerns regarding adequate decompression and its long-term consistency. This study introduced the extended form of TELF, an advanced technique, to provide more extensive decompression using the same approach. Thus, this study aimed to describe the surgical technique and clinical outcomes of this technique. : This retrospective cohort study included patients who underwent conventional ( = 67) or extended ( = 64) TELF. The surgical procedure involved a transforaminal approach with endoscopic decompression, including the removal of the tip of the superior articular process, foraminal ligament, and ligamentum flavum (conventional group), or additional decompression, involving the isthmus and portions of the superior and inferior pedicle walls (extended group). Clinical outcomes were assessed using the visual analog pain scale, Oswestry disability index, and modified Macnab criteria. : Despite the longer surgical duration, the extended TELF group tended to show better outcomes in terms of the VAS and ODI scores at the early and final 2-year follow-ups ( < 0.05). The overall success rates were 92.19% and 85.07% in the extended and conventional groups, respectively. No difference was observed in surgical complications between the two groups. : Extended TELF, a refined endoscopic technique, achieves better effects than conventional TELF with a lower risk of nerve root irritation by creating a sufficiently safe resection margin. The results support the use of an extended TELF as an advanced form of endoscopic foraminal decompression.
经椎间孔内镜下腰椎椎间孔切开术（TELF）是一种用于治疗腰椎椎间孔狭窄的新兴微创手术技术。然而，由于对充分减压及其长期稳定性的担忧，其有效性存在争议。本研究引入了TELF的扩展形式，这是一种先进技术，旨在通过相同的方法提供更广泛的减压。因此，本研究旨在描述该技术的手术方法和临床结果。：这项回顾性队列研究纳入了接受传统TELF（n = 67）或扩展TELF（n = 64）的患者。手术过程采用经椎间孔入路并进行内镜减压，包括切除上关节突尖端、椎间孔韧带和黄韧带（传统组），或进行额外减压，包括峡部以及上下椎弓根壁的部分（扩展组）。使用视觉模拟疼痛量表、Oswestry功能障碍指数和改良Macnab标准评估临床结果。：尽管手术时间较长，但在早期和最终2年随访时，扩展TELF组在VAS和ODI评分方面往往表现出更好的结果（P < 0.05）。扩展组和传统组的总体成功率分别为92.19%和85.07%。两组在手术并发症方面未观察到差异。：扩展TELF是一种精细的内镜技术，通过创造足够安全的切除边缘，比传统TELF取得更好的效果，且神经根刺激风险更低。结果支持将扩展TELF作为内镜下椎间孔减压的一种先进形式。
