{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T01:41:21Z","timestamp":1782178881719,"version":"3.54.5"},"reference-count":22,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>Persistent lumbar foraminal stenosis (LFS) is one of the most common reasons for poor postoperative outcomes and is a major contributor to \u201cfailed back surgery syndrome.\u201d The authors describe a new surgical strategy for LFS based on anatomical considerations using 3D image fusion with MRI\/CT analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>A retrospective review was conducted on 78 consecutive patients surgically treated for LFS at the lumbosacral junction (2013\u20132017). The location and extent of stenosis, including the narrowest site and associated pathology (bone or soft tissue), were measured using 3D image fusion with MRI\/CT. Stenosis was defined as medial intervertebral foraminal (MF; inner edge to pedicle center), lateral intervertebral foraminal (LF; pedicle center to outer edge), or extraforaminal (EF; outside the pedicle). Lumbar (low-back pain, leg pain) and patient satisfaction visual analog scale (VAS) scores and Japanese Orthopaedic Association (JOA) scores were evaluated. Surgical outcome was evaluated 2 years postoperatively.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Most instances of stenosis existed outside the pedicle\u2019s center (94%), including LF (58%), EF (36%), and MF (6%). In all MF cases, stenosis resulted from soft-tissue structures. The narrowest stenosis sites were localized around the pedicle\u2019s outer border. The areas for sufficient nerve decompression were extended in MF+LF (10%), MF+LF+EF (14%), LF+EF (39%), LF (11%), and EF (26%). No iatrogenic pars interarticularis damage occurred. The JOA score was 14.9 \u00b1 2.6 points preoperatively and 22.4 \u00b1 3.5 points at 2 years postoperatively. The JOA recovery rate was 56.0% \u00b1 18.6%. The VAS score (low-back and leg pain) was significantly improved 2 years postoperatively (p &lt; 0.01). According to patients\u2019 self-assessment of the minimally invasive surgery, 62 (79.5%) chose \u201csurgery met my expectations\u201d at follow-up. Nine patients (11.5%) selected \u201cI did not improve as much as I had hoped but I would undergo the same surgery for the same outcome.\u201d<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Most LFS existed outside the pedicle\u2019s center and was rarely noted in the pars region. The main regions of stenosis were localized to the pedicle\u2019s outer edge. Considering this anatomical distribution of LFS, the authors recommend that lateral fenestration should be the first priority for foraminal decompression. Other surgical options including foraminotomy, total facetectomy, and hemilaminectomy likely require more bone resections than LFS treatment. The microendoscopic surgery results were very good, indicating that this minimally invasive surgery was suitable for treating this disease.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2020.5.spine20352","type":"journal-article","created":{"date-parts":[[2020,8,7]],"date-time":"2020-08-07T07:16:43Z","timestamp":1596784603000},"page":"789-795","source":"Crossref","is-referenced-by-count":15,"title":["Microendoscopic decompression for lumbosacral foraminal stenosis: a novel surgical strategy based on anatomical considerations using 3D image fusion with MRI\/CT"],"prefix":"10.3171","volume":"33","author":[{"given":"Shizumasa","family":"Murata","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Wakayama Medical University, Wakayama;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akihito","family":"Minamide","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Wakayama Medical University, Wakayama;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Iwasaki","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Wakayama Medical University, Wakayama;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yukihiro","family":"Nakagawa","sequence":"additional","affiliation":[{"name":"Spine Care Center, Wakayama Medical University Kihoku Hospital, Wakayama;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Hashizume","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Wakayama Medical University, Wakayama;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasutsugu","family":"Yukawa","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Wakayama Medical University, Wakayama;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shunji","family":"Tsutsui","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Wakayama Medical University, Wakayama;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masanari","family":"Takami","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Wakayama Medical University, Wakayama;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Motohiro","family":"Okada","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Wakayama Medical University, Wakayama;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keiji","family":"Nagata","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Wakayama Medical University, Wakayama;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Munehito","family":"Yoshida","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Sumiya Orthopaedic Hospital, Wakayama, Japan; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew J.","family":"Schoenfeld","sequence":"additional","affiliation":[{"name":"Microendoscopic Spine Institute and Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew K.","family":"Simpson","sequence":"additional","affiliation":[{"name":"Microendoscopic Spine Institute and Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Yamada","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Wakayama Medical University, Wakayama;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1","key":"b1","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1097\/00007632-198401000-00008","article-title":"Alar transverse process impingement of the L5 spinal nerve: the far-out syndrome","volume":"9","author":"Wiltse LL","year":"1984","unstructured":"Wiltse LL, Guyer RD, Spencer CW,  Alar transverse process impingement of the L5 spinal nerve: the far-out syndrome. 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