• Shizumasa Murata, Masanari Takami, Hiroshi Iwasaki, Hiroshi Hashizume, Yasutsugu Yukawa, Akihito Minamide, Yukihiro Nakagawa, Shunji Tsutsui, Motohiro Okada, Keiji Nagata, Yuyu Ishimoto, Masatoshi Teraguchi, Hiroki Iwahashi, Kimihide Murakami, Ryo Taiji, Takuhei Kozaki, Yoji Kitano, Munehito Yoshida, and Hiroshi Yamada.
• Department of Orthopedic Surgery, Shingu Municipal Medical Center, Shingu, Wakayama, Japan; Department of Orthopedic Surgery, Wakayama Medical University, Wakayama, Japan.
• World Neurosurg. 2024 Feb 1; 182: e570e578e570-e578.

ObjectiveThe objective of this study was to determine the long-term outcomes of microendoscopic foraminotomy in treating lumbar foraminal stenosis and identify the optimal extent of decompression that yields improved results and fewer complications.MethodsA retrospective cohort study reviewed the medical records of 95 consecutive patients who underwent microendoscopic foraminotomy for lumbar foraminal stenosis. Clinical outcomes were assessed using the Japanese Orthopaedic Association scoring system and visual analog scale for low back and leg pain. Surgical success was determined by meeting significant improvement thresholds for back and leg pain at 2 years postoperatively. Multiple regression analysis identified factors associated with improved pain scores. Receiver operating characteristic curve analysis determined the cut-off values for successful surgeries.ResultsSignificant improvements were observed in Japanese Orthopaedic Association and visual analog scale scores for back and leg pain 2 years postoperatively compared with preoperative scores (P < 0.0001) and sustained over a ≥5-year follow-up period. Reoperation rates were low and did not significantly increase over time. Multiple regression analysis identified occupancy of the vertebral osteophytes and bulging intervertebral discs (O/D complex) as surgical success predictors. A 45.0% O/D complex occupancy cutoff value was determined, displaying high sensitivity and specificity for predicting surgical success.ConclusionsThis study provides evidence supporting the long-term efficacy of microendoscopic foraminotomy for lumbar foraminal stenosis and predicting surgical success. The 45.0% O/D complex occupancy cut-off value can guide patient selection and outcome prediction. These insights contribute to informed surgical decision-making and underscore the importance of evaluating the O/D complex in preoperative planning and predicting outcomes.Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.

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