scholarly journals AB1325-HPR THE TRANSITION FROM PEDIATRIC TO ADULT RHEUMATOLOGY OF 347 PATIENTS AT A SINGLE CENTER

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1951.2-1952
Author(s):  
S. Ugurlu ◽  
B. H. Egeli ◽  
A. Adrovic ◽  
K. Barut ◽  
S. Sahin ◽  
...  
Keyword(s):  
Lupus Erythematosus ◽  
Hip Prosthesis ◽  
Transition Process ◽  
Current Treatment ◽  
Left Knee ◽  
Leg Pain ◽  
Rheumatology Clinic ◽  
Treatment Information ◽  
The Mean

Background:Pediatric to adult rheumatology transition can be a challenge for both the patient and the clinician, especially in rheumatology as it includes chronic diseases with close follow-up.Objectives:The objective of this study is to understand our tertiary rheumatology center patient demographic transitioning from pediatric to adult rheumatology in order to design prospective studies enhancing the evidence of transition recommendations.Methods:Patients included in this study are regularly followed-up in our adult rheumatology clinic and were regularly followed up in our pediatric rheumatology clinic in the past. They were all diagnosed with a rheumatologic condition receiving treatment. The patient files were assessed to have a better understanding of their demographic, disease and treatment information.Results:Our cohort includes 347 patients diagnosed with a variety of conditions that are Familial Mediterranean Fever (FMF) (n=216), Juvenile Idiopathic Arthritis (JIA) (n=56), Juvenile Spondyloarthritis (jSPA) (n=39), Systemic Lupus Erythematosus (SLE) (n=20), Behçet’s Disease (n=7) and the rest of the rheumatologic conditions with less than 5 patients each. The mean age of the patients during transition, mean age of diagnosis, and follow-up duration are 21.34±1.7, 10.4±4.18, and 10.82±4.4 in respective order. The treatment regimens the patients received are summarized in Table 1.Table 1.Current Treatment Information of the PatientsCurrent Treatment InformationDMARD26Colchicine23Adalimumab21Etanercept10NSAID4Tocilizumab3Cyclophosphamide3Rituximab2Prednisolone7Mycophenolate Mofetil1Canakinumab1Seven patients had FMF related attacks. In addition to attacks, one FMF patient had bilateral ankle pain and one patient had leg pain. One patient out of three diagnosed with Takayasu’s disease was still symptomatic. One patient had uveitis-related symptoms. One patient diagnosed with SLE had skin dryness. Furthermore, there were patients with sequelae formation. One patient diagnosed with oligoarticular JIA (oJIA) had bilateral hip sequela with the additional left hip prosthesis. One oJIA patient had micrognathia, and one had left knee sequela. One pJIA patient had small joint sequelae. One sJIA patient had bilateral hip sequelae. One jSPA patient had enthesopathy. One FMF patient had proteinuria due to amyloidosis formation. Another FMF patient had hip surgery due to sequela.Conclusion:Our center had patients with a variety of conditions with different natures of diseases. EULAR recommends the transition process to start no later than 14 years of age; however, this process started at the mean age of 21 in our patients. In most of these patients, especially the ones diagnosed with FMF, the control of disease activity was maintained. The transition of these different clinical entities might require certain amendments to the standard of care. For future references, we will be able to understand more about the adulthood prognosis of these clinical entities.Disclosure of Interests:None declared

Single-position prone lateral transpsoas approach: early experience and outcomes

2021 ◽  
pp. 1-8
Author(s):  
S. Harrison Farber ◽  
Komal Naeem ◽  
Malika Bhargava ◽  
Randall W. Porter
Keyword(s):  
Case Series ◽  
Leg Pain ◽  
Consecutive Case ◽  
Intraoperative Radiation ◽  
Invasive Approach ◽  
Transpsoas Approach ◽  
Estimated Blood Loss ◽  
The Mean ◽  
Level Fusion

OBJECTIVE Lateral lumbar interbody fusion (LLIF) via a transpsoas approach is a workhorse minimally invasive approach for lumbar arthrodesis that is often combined with posterior pedicle screw fixation. There has been increasing interest in performing single-position surgery, allowing access to the anterolateral and posterior spine without requiring patient repositioning. The feasibility of the transpsoas approach in patients in the prone position has been reported. Herein, the authors present a consecutive case series of all patients who underwent single-position prone transpsoas LLIF performed by an individual surgeon since adopting this approach. METHODS A retrospective review was performed of a consecutive case series of adult patients (≥ 18 years old) who underwent single-position prone LLIF for any indication between October 2019 and November 2020. Pertinent operative details (levels, cage use, surgery duration, estimated blood loss, complications) and 3-month clinical outcomes were recorded. Intraoperative and 3-month postoperative radiographs were reviewed to assess for interbody subsidence. RESULTS Twenty-eight of 29 patients (97%) underwent successful treatment with the prone lateral approach over the study interval; the approach was aborted in 1 patient, whose data were excluded. The mean (SD) age of patients was 67.9 (9.3) years; 75% (21) were women. Thirty-nine levels were treated: 18 patients (64%) had single-level fusion, 9 (32%) had 2-level fusion, and 1 (4%) had 3-level fusion. The most commonly treated levels were L3–4 (n = 15), L2–3 (n = 12), and L4–5 (n = 11). L1–2 was fused in 1 patient. The mean operative time was 286.5 (100.6) minutes, and the mean retractor time was 29.2 (13.5) minutes per level. The mean fluoroscopy duration was 215.5 (99.6) seconds, and the mean intraoperative radiation dose was 170.1 (94.8) mGy. Intraoperative subsidence was noted in 1 patient (4% of patients, 3% of levels). Intraoperative lateral access complications occurred in 11% of patients (1 cage repositioning, 2 inadvertent ruptures of anterior longitudinal ligament). Subsidence occurred in 5 of 22 patients (23%) with radiographic follow-up, affecting 6 of 33 levels (18%). Postoperative functional testing (Oswestry Disability Index, SF-36, visual analog scale–back and leg pain) identified significant improvement. CONCLUSIONS This single-surgeon consecutive case series demonstrates that this novel technique is well tolerated and has acceptable clinical and radiographic outcomes. Larger patient series with longer follow-up are needed to further elucidate the safety profile and long-term outcomes of single-position prone LLIF.

Neurogenic claudication associated with posterior vertebral rim fractures in children

2012 ◽  
Vol 10 (3) ◽  
pp. 241-245 ◽  
Author(s):  
Jonathan G. Thomas ◽  
Jerome Boatey ◽  
Alison Brayton ◽  
Andrew Jea
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Signs And Symptoms ◽  
Leg Pain ◽  
Neurogenic Claudication ◽  
Pediatric Age Group ◽  
Fractures In Children ◽  
The Mean

Object Outside of the patient population with achondroplasia, neurogenic claudication is rare in the pediatric age group. Neurogenic claudication associated with posterior vertebral rim fracture is even more uncommon but nonetheless causes pain and disability in affected children and adolescents. The purpose of this study was to describe the surgical results of 3 adolescents presenting with neurogenic claudication and posterior vertebral rim fracture when treated with laminectomy alone. Methods The medical and operative records of the 3 pediatric patients were retrospectively reviewed. Presenting signs and symptoms and CT findings, such as the interpedicular distances between T-12 and L-5, were obtained. Perioperative results were assessed, including operative time, blood loss, length of hospital stay, and complications. Findings at latest follow-up were also recorded, including a patient satisfaction survey. Results The 3 patients (1 girl and 2 boys) had a mean age of 14.7 years (range 14–15 years) and underwent follow-up for a mean of 11.3 months (range 5–18 months). Notable preoperative signs and symptoms included back pain (all patients), leg pain (all patients), leg numbness (1 patient), and leg weakness (1 patient). No patient presented with bowel and/or bladder dysfunction. The mean blood loss during laminectomy was 123 ml (range 20–300 ml), and the mean length of hospital stay was 4.3 days (range 3–6 days). On average, decompression was performed at 2.2 levels (range 2–2.5 levels). All 3 patients reported at most recent follow-up that they were “satisfied” with the surgery. There was 1 complication of instability from an iatrogenic pars fracture, which required reoperation and posterior instrumented fusion. Conclusions To the best of the authors' knowledge, this report represents the first surgical series of pediatric neurogenic claudication associated with posterior vertebral rim fractures. Pediatric neurosurgeons may infrequently encounter neurogenic claudication associated with a posterior vertebral rim fracture in children. To treat children with neurogenic claudication associated with posterior vertebral rim fractures, a simple laminectomy may be a safe and efficacious alternative to discectomy and removal of fracture fragments.

Evolution of retinal changes measured by optical coherence tomography in the assessment of hydroxychloroquine ocular safety in patients with systemic lupus erythematosus

Lupus ◽  
2019 ◽  
Vol 28 (4) ◽  
pp. 555-559 ◽  
Author(s):  
D Martín-Iglesias ◽  
J Artaraz ◽  
A Fonollosa ◽  
A Ugarte ◽  
A Arteagabeitia ◽  
...  
Keyword(s):  
Risk Factors ◽  
Optical Coherence Tomography ◽  
Lupus Erythematosus ◽  
Pigment Epithelium ◽  
Retinal Pigment ◽  
Optical Coherence ◽  
The Mean ◽  
Sd Oct

Objective The objective of this report is to analyse retinal changes over a five-year period, assessed by spectral domain-optical coherence tomography (SD-OCT), in patients from the Lupus-Cruces cohort treated with hydroxychloroquine (HCQ). Methods SD-OCT screening was performed annually between 2012 and 2017. Average macular thickness (AMT), ganglion cell layer thickness (GCLT) and qualitative data of retinal pigment epithelium (RPE) and external retina (ExtR) were collected prospectively. We compared data from 2012 (first) and 2017 (second) SD-OCT. Results We studied 110 patients and 195 eyes. No cases of HCQ toxicity were detected. At the time of the second SD-OCT, 99% patients had taken a daily dose of HCQ ≤5 mg/kg/day. The median time on HCQ was 133 months. The mean AMT and GCLT were significantly lower in both eyes at the second SD-OCT; however, all the differences were clinically insignificant at less than 1%. Qualitative analysis of RPE and ExtR showed no significant changes. Similar results were found among patients with risk factors for retinopathy. The comparison of patients with and without risk factors showed no differences. Conclusions This study shows clinically irrelevant retinal changes in an SLE cohort on HCQ treatment over a five-year follow-up. Our findings support the safety of long-term HCQ at doses ≤5 mg/kg/day.

Posterolateral percutaneous endoscopic lumbar foraminotomy for L5—S1 foraminal or lateral exit zone stenosis

2003 ◽  
Vol 99 (3) ◽  
pp. 320-323 ◽  
Author(s):  
Yong Ahn ◽  
Sang-Ho Lee ◽  
Woo-Min Park ◽  
Ho-Yeon Lee
Keyword(s):  
Ligamentum Flavum ◽  
Leg Pain ◽  
Foraminal Stenosis ◽  
Fluoroscopic Guidance ◽  
Awake Patient ◽  
Content Type ◽  
Simple Alternative ◽  
The Mean ◽  
Fine Print

✓ The purpose of this study was to determine the efficacy and feasibility of posterolateral percutaneous endoscopic lumbar foraminotomy (PELF) for foraminal or lateral exit zone stenosis of the L5—S1 level in the awake patient. Twelve consecutive patients with L5—S1 foraminal stenosis and associated leg pain underwent PELF between May 2001 and July 2002. Under fluoroscopic guidance, posterolateral endoscopic foraminal decompression was performed using a bone reamer, endoscopic forceps, and a laser. Using this new technique, the authors removed part of the hypertrophied superior facet, thickened ligamentum flavum, and protruded disc compressing the exiting (L-5) nerve root. Clinical outcome was measured using the Macnab criteria. The mean follow-up period was 12.9 months. All the patients were discharged within 24 hours. Satisfactory (excellent or good) results were demonstrated in 10 patients. There was no complication. The PELF procedure provides a simple alternative for treating lumbar foraminal or lateral exit zone stenosis in selected cases. The authors found that the posterolateral endoscopic approach to the L5—S1 foramen was usually possible and that using a bone reamer to undercut the superior facet was effective.

CAN PATIENTS WITH SAGITTALLY WELL-COMPENSATED LUMBAR DEGENERATIVE KYPHOSIS BENEFIT FROM SURGICAL TREATMENT FOR INTRACTABLE BACK PAIN?

Neurosurgery ◽  
2009 ◽  
Vol 64 (1) ◽  
pp. 115-121 ◽  
Author(s):  
Jee-Soo Jang ◽  
Sang-Ho Lee ◽  
Jung Mok Kim ◽  
Jun-Hong Min ◽  
Kyung-Mi Han ◽  
...  
Keyword(s):  
Back Pain ◽  
Oswestry Disability Index ◽  
Lumbar Lordosis ◽  
Rating Scale ◽  
Numeric Rating Scale ◽  
Leg Pain ◽  
Compensatory Mechanisms ◽  
The Mean ◽  
Numeric Rating

Abstract OBJECTIVE To analyze pre- and postoperative x-rays of sagittal spines and to review the surgical results of 21 patients with lumbar degenerative kyphosis whose spines were sagittally well compensated by compensatory mechanisms but who continued to suffer from intractable back pain METHODS We performed a retrospective review of 21 patients treated with combined anterior and posterior spinal arthrodesis. Inclusion criteria were: lumbar degenerative kyphosis patients with intractable back pain and whose spines were sagittally well compensated by a compensatory mechanism, defined as a C7 plumb line to the posterior aspect of the L5–S1 disc of less than 5 cm. Outcome variables included: radiographic measures of preoperative, postoperative, and follow-up films; clinical assessment using the mean Numeric Rating Scale, Oswestry Disability Index, and Patient Satisfaction Index; and a review of postoperative complications. RESULTS All patients were female (mean age, 64.5 years; age range, 50–74 years). The mean preoperative sagittal imbalance was 19.5 (± 17.6) mm, which improved to −15.8 (± 22.2) mm after surgery. Mean lumbar lordosis was 13.2 degrees (± 15.3) before surgery and increased to 38.1 degrees (± 14.4) at follow-up (P < 0.0001). Mean thoracic kyphosis was 5.5 degrees (± 10.2) before surgery and increased to 18.9 degrees (± 12.4) at follow-up (P < 0.0001). Mean sacral slopes were 12.9 degrees (± 11.1) before surgery and increased to 26.3 degrees (± 9.6) at follow-up (P < 0.0001). The mean Numeric Rating Scale score improved from 7.8 (back pain) and 8.1 (leg pain) before surgery to 3.0 (back pain) and 2.6 (leg pain) after surgery (P < 0.0001). The mean Oswestry Disability Index scores improved from 56.2% before surgery to 36.7% after surgery (P < 0.0001). In 18 (85.5%) of 21 patients, satisfactory outcomes were demonstrated by the time of the last follow-up assessment. CONCLUSION This study shows that even lumbar degenerative kyphosis patients with spines that are sagittally well compensated by compensatory mechanisms may suffer from intractable back pain and that these patients can be treated effectively by the restoration of lumbar lordosis.

Encouraging Medium-term Results of Wallis Second Generation Dynamic Stabilisation Device

2018 ◽  
Vol 20 (2) ◽  
pp. 149-156
Author(s):  
Awaiz Ahmed ◽  
Abdulla Jawed ◽  
Murali Venkatesan ◽  
James Doyle
Keyword(s):  
Oswestry Disability Index ◽  
Second Generation ◽  
Lumbar Disc ◽  
Leg Pain ◽  
Medium Term ◽  
Disc Disease ◽  
Lumbar Disc Disease ◽  
Dynamic Stabilisation ◽  
The Mean

Background. Aim of this prospective study was to evaluate safety and efficacy of second generation Wallis system for degenerative lumbar disc disease. Material and methods. 25 patients underwent discectomy and insertion of Wallis system. Outcome assessment was done using Modified Oswestry disability index (ODI) and visual analogue scale (VAS) for backache and leg pain. Results. The mean follow-up was 20.5 months. The mean VAS for backache and leg pain showed significant improvement from 7.2 to 3.0 (p<0.001) and mean modified Oswestry disability index showed significant improvement from 59.1 to 24.7 (p<0.001). Only one patient (4%) underwent revision surgery for persistent pain due to granulation tissue deep to the implant. There were no other complications. Conclusion. The Wallis spine system is a safe and effective implant for treating degenerative lumbar disc disease.

scholarly journals A novel noninstrumented surgical approach for foramen reconstruction for isthmic spondylolisthesis in patients with radiculopathy: preliminary clinical and radiographic outcomes

2018 ◽  
Vol 44 (1) ◽  
pp. E7
Author(s):  
Jochem K. H. Spoor ◽  
Alof H. G. Dallenga ◽  
Pravesh S. Gadjradj ◽  
Luuk de Klerk ◽  
Frans C. van Biezen ◽  
...  
Keyword(s):  
Surgical Approach ◽  
Autologous Bone Graft ◽  
Posterolateral Fusion ◽  
Leg Pain ◽  
Safe Procedure ◽  
Isthmic Spondylolisthesis ◽  
Bony Fusion ◽  
Duration Of Surgery ◽  
The Mean

OBJECTIVEThe health care costs for instrumented spine surgery have increased dramatically in the last few decades. The authors present a novel noninstrumented surgical approach for patients with isthmic spondylolisthesis, with clinical and radiographic results.METHODSCharts of patients who underwent this technique were reviewed. The procedure consisted of nerve root decompression by reconstruction of the intervertebral foramen. This was achieved by removal of the pedicle followed by noninstrumented posterolateral fusion in which autologous bone graft from the right iliac crest was used. Outcomes regarding radicular complaints, bony fusion, progression of the slip, and complications were evaluated using patient history and radiographs obtained at follow-up intervals of 3–18 months after surgery.RESULTSA total of 58 patients with a mean age of 47 years were treated with this method. Partial removal of the pedicle was performed in 93.1% of the cases, whereas in 6.9% of the cases the entire pedicle was removed. The mean duration of surgery was 216.5 ± 54.5 minutes (range 91–340 minutes). The mean (± SD) duration of hospitalization was 10.1 ± 2.9 days (range 5–18 days).After 3 months of follow-up, 86% of the patients reported no leg pain, and this dropped to 81% at last follow-up. Radiographic follow-up showed bony fusion in 87.7% of the patients. At 1 year, 5 patients showed progression of the slip, which in 1 patient prompted a second operation within 1 year. No major complications occurred.CONCLUSIONSTreatment of isthmic spondylolisthesis by reconstruction of the intervertebral neuroforamen and posterolateral fusion in situ is a safe procedure and has comparable results with the existing techniques. Cost-effectiveness research comparing this technique to conventional instrumented fusion techniques is necessary to evaluate the merits for both patients and society.

Transforaminal Percutaneous Endoscopic Lumbar Diskectomy for Downmigrated Disk Herniations: Lever-Up, Rotate, and Tilt Technique

2017 ◽  
Vol 79 (02) ◽  
pp. 163-168 ◽  
Author(s):  
Sang Soo Eun ◽  
Sang-Ho Lee ◽  
H. Erken
Keyword(s):  
Retrospective Review ◽  
Spinal Surgery ◽  
Oswestry Disability Index ◽  
Leg Pain ◽  
Analog Scale ◽  
Vas Scores ◽  
The Mean ◽  
Endoscopic Spinal Surgery ◽  
Soft Disk

Background and Study Aims Although transforaminal percutaneous endoscopic lumbar diskectomy (PELD) offers certain advantages in the treatment of disk herniations, it used to be limited to nonmigrated or low-migrated herniations. With improvements in endoscopic spinal surgery, the range of indications for PELD has expanded. Various techniques including transforaminal and interlaminar approaches for migrated disk herniations are described in the literature. This study describes a transforaminal PELD approach to address downmigrated intracanal soft disk herniations effectively using the lever-up, rotate, and tilt technique. Patients and Methods We performed a retrospective review of 18 patients who had been operated on with the described technique between October 2012 and December 2015. We assessed clinical outcomes using the visual analog scale (VAS) for back and leg pain and the Oswestry Disability Index (ODI) preoperatively at their respective clinical visits and postoperatively at the patients' final follow-up examinations. Results The mean preoperative VAS scores for back and leg pain were 3.75 + 1.34 (range: 2–6) and 8.3 + 0.6 (range: 8–10), respectively. The mean preoperative ODI was 67.3 + 15.3 (range: 48–90). The mean VAS scores for back and leg pain improved to 1.38 + 1.58 (range: 0–6) and 1.19 + 0.75 (range: 0–3), respectively, at the last follow-up. The mean ODI also improved to 14.1 + 6.2 (range: 8–30) at the last follow-up. All differences between the preoperative and last follow-up scores were statistically significant (p < 0.05), Two surgeries failed because of a remnant disk fragment. Conclusions The lever-up, rotate, and tilt technique for transforaminal PELD is an effective maneuver to treat downmigrated disk herniations in selected patients by experienced surgeons.

scholarly journals Short-term effectiveness of precise safety decompression via double percutaneous lumbar foraminoplasty and percutaneous endoscopic lumbar decompression for lateral lumbar spinal canal stenosis: a prospective cohort study

2020 ◽  
Author(s):  
Yu Wang ◽  
Mingyan Deng ◽  
Hao Wu ◽  
Ye Wu ◽  
Chuan Guo ◽  
...  
Keyword(s):  
Cohort Study ◽  
Clinical Outcomes ◽  
Prospective Cohort ◽  
Spinal Canal ◽  
Leg Pain ◽  
Short Term ◽  
Postoperative Mri ◽  
The Mean ◽  
Lumbar Spinal

Abstract Purpose This prospective cohort study reports on a new technique, namely precise safety decompression via double percutaneous lumbar foraminoplasty (DPLF) and percutaneous endoscopic lumbar decompression (PELD) for lateral lumbar spinal canal (LLSC) stenosis, and its short-term clinical outcomes.Methods The study analyzed 69 patients with single-level LLSC stenosis simultaneously occurring in both zones 1 and 2 (defined as retrodiscal space and upper bony lateral recess respectively by new LLSC classification) who underwent DPLF–PELD from November 2018 to April 2019. Clinical outcomes were evaluated according to preoperative, three months postoperatively, and last follow-up, via leg pain/low back pain (LBP) visual analog scale (VAS) scores, Oswestry disability index (ODI) scores, and the Macnab criteria. The postoperative MRI and CT were used to confirm the complete decompression, and flexion-extension x-rays at the last follow-up were used to observe lumbar stability.Results All patients successfully underwent DPLF–PELD, and the stenosis was completely decompressed, confirmed by postoperative MRI and CT. The mean follow-up duration was 13 months (range: 8–17 months). The mean preoperative leg pain VAS score is 7.05 ± 1.04 (range 5–9), which decreased to 1.03 ± 0.79(range: 0–3) at three months postoperatively and to 0.75 ± 0.63 (range: 0–2) by the last follow-up visit(p < 0.05). The mean preoperative ODI was 69.8 ± 9.05 (range: 52–85), which decreased to 20.3 ± 5.52 (range: 10–35) at the third month postoperatively and to 19.6 ± 5.21 (range: 10–34) by the final follow-up visit(p < 0.05). The satisfactory (excellent or good) results were 94.2%. There was one patient with aggravated symptoms, which were relieved after an open surgery. Two patients had a dural tear, and two patients suffered postoperative LBP. No recurrence or segmental instability was observed at the final follow-up.Conclusion DPLF–PELD could be a good alternative for the treatment of LLSC stenosis patients whose stenosis occurred in both zones 1 and 2.Trial registration Chinese Clinical Trial Registry (ChiCTR1800019551). Registered 18 November 2018.

Extraforaminal approach of biportal endoscopic spinal surgery: a new endoscopic technique for transforaminal decompression and discectomy

2018 ◽  
Vol 28 (5) ◽  
pp. 492-498 ◽  
Author(s):  
Jae-Sung Ahn ◽  
Ho-Jin Lee ◽  
Dae-Jung Choi ◽  
Ki-young Lee ◽  
Sung-jin Hwang
Keyword(s):  
Clinical Outcomes ◽  
Disc Herniation ◽  
Spinal Surgery ◽  
Operative Time ◽  
Endoscopic Technique ◽  
Leg Pain ◽  
Vas Score ◽  
The Mean ◽  
Endoscopic Spinal Surgery

This study was performed to describe the extraforaminal approach of biportal endoscopic spinal surgery (BESS) as a new endoscopic technique for transforaminal decompression and discectomy and to demonstrate the clinical outcomes of this new procedure for the first time. Twenty-one patients (27 segments) who underwent the extraforaminal approach of BESS between March 2015 and April 2016 were enrolled according to the inclusion and exclusion criteria. The operative time (minutes/level) and complications after the procedure were recorded. The visual analog scale (VAS) score was checked to assess the degree of radicular leg pain preoperatively and at the time of the last follow-up. The modified Macnab criteria were used to examine the clinical outcomes at the time of the last follow-up. The mean duration of the follow-up period was 14.8 months (minimum duration 12 months). The mean operative time was 96.7 minutes for one level. The mean VAS score for radicular leg pain dropped from a preoperative score of 7.5 ± 0.9 to a final follow-up score of 2.5 ± 1.2 (p < 0.001). The final outcome according to the modified Macnab criteria was excellent in 5 patients (23.8%), good in 12 (57.2%), fair in 4 (19.0%), and poor in 0. Therefore, excellent or good results (a satisfied outcome) were obtained in 80.9% of the patients. Complications were limited to one dural tear (4.8%). The authors found that the extraforaminal approach of BESS was a feasible and advantageous endoscopic technique for the treatment of foraminal lesions, including stenosis and disc herniation. They suggest that this technique represents a useful, alternative, minimally invasive method that can be used to treat lumbar foraminal stenosis and disc herniation.

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