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Peer-reviewedCC BYWorld Neurosurgery: X

Mid-term outcomes of transforaminal endoscopic lumbar foraminotomy for radiographically stable adjacent segment disease after lumbar fusion: A retrospective case series

  • Jorge Felipe Ramírez León
  • José Gabriel Rugeles Ortiz1
  • Carolina Ramírez Martínez
  • Nicolás Prada Ramírez2
  • Greiska Gisela Benítez González3
  • Kai-Uwe Lewandrowski
  • Viviana Marcela Plazas Bedoya4
  • Sergio Nicolás Diaz Marín5
  • Gabriel Oswaldo Alonso Cuéllar
5 affiliations
  1. 1Latin American Endoscopic Spine Surgeons LESS Invasiva Academy, Bogotá, D.C., Colombia; Clínica Reina Sofia Pediátrica y de la Mujer, Departamento de Ortopedia y Traumatología, Clínica Colsanitas S.A., Bogotá, D.C., Colombia
  2. 2Latin American Endoscopic Spine Surgeons LESS Invasiva Academy, Bogotá, D.C., Colombia; Clínica Foscal Internacional, Bucaramanga, Colombia
  3. 3Fellowship Visiting - Latin American Endoscopic Spine Surgeons, LESS Invasiva Academy, Bogotá, D.C., Colombia
  4. 4Clínica Reina Sofia Pediátrica y de la Mujer, Departamento de Ortopedia y Traumatología, Clínica Colsanitas S.A., Bogotá, D.C., Colombia
  5. 5Fundación Universitaria Sanitas, Bogotá, D.C., Colombia
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Abstract

Objective: To evaluate clinical and functional outcomes after transforaminal endoscopic lumbar foraminotomy (TELF) for symptomatic adjacent segment disease (ASD) in patients without frank dynamic instability after lumbar fusion. Methods: This retrospective case series included 29 patients available for outcome analysis after transforaminal endoscopic lumbar foraminotomy (TELF). Patients with >3 mm sagittal translation or >10° angular motion on flexion-extension radiographs were excluded. Outcomes were pain measured with a Visual Analog Scale (VAS), Oswestry Disability Index (ODI), modified MacNab category, operative parameters, prior fusion construct type, anatomic relationship of the endoscopic level(s) to the prior fusion, and perioperative complications. Median follow-up was 24 months (IQR 13-48; range, 12-144 months). Results: Median age was 70.5 years (IQR 58.5-78.8); 26 of 29 patients (89.7%) had at least one comorbidity, and 25 (86.2%) were ASA class II or III. Median blood loss was 20 mL. Median VAS decreased from 8 to 2 and median ODI from 50 to 16 (both p < 0.001). All 29 patients met the prespecified MCID thresholds for VAS and ODI, and 25 (86.2%) had a satisfactory modified MacNab outcome. One perioperative motor deficit resolved without long-term sequelae. Conclusions: In this selected cohort with radiographically stable symptomatic ASD, TELF was associated with clinically meaningful improvements in pain and disability at the available final follow-up and low observed intraoperative blood loss. These uncontrolled findings support feasibility but do not establish comparative safety, superiority, or longitudinal durability.

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Cite

BibTeXRIS
BibTeX
@article{leon2026midterm,
  title = {{Mid-term outcomes of transforaminal endoscopic lumbar foraminotomy for radiographically stable adjacent segment disease after lumbar fusion: A retrospective case series}},
  author = {Jorge Felipe Ramírez León and José Gabriel Rugeles Ortiz and Carolina Ramírez Martínez and Nicolás Prada Ramírez and Greiska Gisela Benítez González and Kai-Uwe Lewandrowski and Viviana Marcela Plazas Bedoya and Sergio Nicolás Diaz Marín and Gabriel Oswaldo Alonso Cuéllar},
  journal = {World Neurosurgery: X},
  year = {2026},
  month = oct,
  doi = {10.1016/j.wnsx.2026.100644},
  url = {https://doi.org/10.1016/j.wnsx.2026.100644},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Mid-term outcomes of transforaminal endoscopic lumbar foraminotomy for radiographically stable adjacent segment disease after lumbar fusion: A retrospective case series
AU  - Jorge Felipe Ramírez León
AU  - José Gabriel Rugeles Ortiz
AU  - Carolina Ramírez Martínez
AU  - Nicolás Prada Ramírez
AU  - Greiska Gisela Benítez González
AU  - Kai-Uwe Lewandrowski
AU  - Viviana Marcela Plazas Bedoya
AU  - Sergio Nicolás Diaz Marín
AU  - Gabriel Oswaldo Alonso Cuéllar
PY  - 2026
DA  - 2026/10/01
JO  - World Neurosurgery: X
DO  - 10.1016/j.wnsx.2026.100644
UR  - https://doi.org/10.1016/j.wnsx.2026.100644
AB  - Objective: To evaluate clinical and functional outcomes after transforaminal endoscopic lumbar foraminotomy (TELF) for symptomatic adjacent segment disease (ASD) in patients without frank dynamic instability after lumbar fusion. Methods: This retrospective case series included 29 patients available for outcome analysis after transforaminal endoscopic lumbar foraminotomy (TELF). Patients with >3 mm sagittal translation or >10° angular motion on flexion-extension radiographs were excluded. Outcomes were pain measured with a Visual Analog Scale (VAS), Oswestry Disability Index (ODI), modified MacNab category, operative parameters, prior fusion construct type, anatomic relationship of the endoscopic level(s) to the prior fusion, and perioperative complications. Median follow-up was 24 months (IQR 13-48; range, 12-144 months). Results: Median age was 70.5 years (IQR 58.5-78.8); 26 of 29 patients (89.7%) had at least one comorbidity, and 25 (86.2%) were ASA class II or III. Median blood loss was 20 mL. Median VAS decreased from 8 to 2 and median ODI from 50 to 16 (both p < 0.001). All 29 patients met the prespecified MCID thresholds for VAS and ODI, and 25 (86.2%) had a satisfactory modified MacNab outcome. One perioperative motor deficit resolved without long-term sequelae. Conclusions: In this selected cohort with radiographically stable symptomatic ASD, TELF was associated with clinically meaningful improvements in pain and disability at the available final follow-up and low observed intraoperative blood loss. These uncontrolled findings support feasibility but do not establish comparative safety, superiority, or longitudinal durability.
SN  - 2590-1397
ER  -