{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:18:53Z","timestamp":1760059133994,"version":"build-2065373602"},"reference-count":42,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,5,21]],"date-time":"2025-05-21T00:00:00Z","timestamp":1747785600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Clinical Medicine Research Institute at Chosun University Hospital (2024)"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: One of the surgical treatments for lumbar foraminal stenosis, full endoscopic foraminotomy, is known for its numerous advantages and favourable clinical outcomes. While previous studies have analyzed preoperative radiological risk factors associated with recurrence within one year after endoscopic foraminal decompression, no research has investigated postoperative radiological changes. The aim of this study is to analyze the radiological changes occurring in cases of early recurrence within six months after endoscopic foraminal decompression. Methods: A retrospective review was conducted on patients with unilateral lumbar foraminal stenosis who underwent full endoscopic foraminotomy at a single institution. The study included 11 recurrent patients who initially experienced symptomatic improvement and sufficient neural decompression on radiological evaluation, but exhibited recurrent radicular pain and radiological restenosis within six months postoperatively. Additionally, 33 control patients with favourable clinical outcomes and no evidence of restenosis were analyzed. Preoperative and postoperative plain X-ray imaging was used to evaluate sagittal and coronal parameters reflecting spinal anatomical characteristics, including disc height, foraminal height, disc wedging, coronal Cobb\u2019s angle, total lumbar lordosis angle, segmental lumbar lordosis angle, and dynamic segmental lumbar lordosis angle. The study aimed to analyze postoperative changes in these parameters between the recurrent and control groups. Clinical outcomes were assessed using the Visual Analog Scale (VAS). Results: There were no significant differences between the groups in terms of age, sex distribution, presence of adjacent segment disease, or existence of Grade 1 spondylolisthesis. Analysis of preoperative and postoperative radiological changes revealed that, in the recurrent group, disc height and foraminal height showed a significant decrease postoperatively, while disc wedging and the coronal Cobb\u2019s angle demonstrated a significant increase. In contrast, the control group exhibited a significant postoperative increase in the total lumbar lordosis angle and segmental lumbar lordosis angle. Conclusions: Progressive worsening of disc wedging and the coronal Cobb\u2019s angle, and reductions in disc and foraminal height, along with minimal improvement in lumbar lordosis following TELF, suggest the presence of irreversible preoperative degenerative changes. Careful radiologic assessment and close postoperative monitoring are essential to identify patients at risk of early recurrence.<\/jats:p>","DOI":"10.3390\/diagnostics15101299","type":"journal-article","created":{"date-parts":[[2025,5,21]],"date-time":"2025-05-21T13:59:43Z","timestamp":1747835983000},"page":"1299","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Postoperative Radiologic Changes in Early Recurrent Lumbar Foraminal Stenosis After Transforaminal Endoscopic Lumbar Foraminotomy for Lower Lumbar Segments"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9955-5107","authenticated-orcid":false,"given":"Chi-Ho","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, College of Medicine, Chosun University, Gwangju 61453, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5514-9257","authenticated-orcid":false,"given":"Pius","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, College of Medicine, Chosun University, Gwangju 61453, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chang-Il","family":"Ju","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, College of Medicine, Chosun University, Gwangju 61453, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6802-3403","authenticated-orcid":false,"given":"Jong-Hun","family":"Seo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, College of Medicine, Chosun University, Gwangju 61453, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1097\/00007632-200002010-00022","article-title":"Spine update. Lumbar foraminal stenosis","volume":"25","author":"Jenis","year":"2000","journal-title":"Spine"},{"key":"ref_2","first-page":"205","article-title":"Foraminal stenosis of the lumbar spine: A review of 65 surgical cases","volume":"30","author":"Jenis","year":"2001","journal-title":"Am. J. Orthop."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Kim, J.Y., Kim, H.S., Jeon, J.B., Lee, J.H., Park, J.H., and Jang, I.T. (2021). The Novel Technique of Uniportal Endoscopic Interlaminar Contralateral Approach for Coexisting L5-S1 Lateral Recess, Foraminal, and Extraforaminal Stenosis and Its Clinical Outcomes. J. Clin. Med., 10.","DOI":"10.3390\/jcm10071364"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1227\/NEU.0000000000000361","article-title":"Percutaneous endoscopic lumbar foraminotomy: An advanced surgical technique and clinical outcomes","volume":"75","author":"Ahn","year":"2014","journal-title":"Neurosurgery"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"131","DOI":"10.14245\/ns.1836046.023","article-title":"Feasibility of Full Endoscopic Spine Surgery in Patients over the Age of 70 Years with Degenerative Lumbar Spine Disease","volume":"15","author":"Kim","year":"2018","journal-title":"Neurospine"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"E6","DOI":"10.3171\/2013.5.FOCUS1377","article-title":"Short-term and long-term outcomes of minimally invasive and open transforaminal lumbar interbody fusions: Is there a difference?","volume":"35","author":"Cheng","year":"2013","journal-title":"Neurosurg. Focus"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1016\/j.jos.2017.10.015","article-title":"State-of-the-art transforaminal percutaneous endoscopic lumbar surgery under local anesthesia: Discectomy, foraminoplasty, and ventral facetectomy","volume":"23","author":"Sairyo","year":"2018","journal-title":"J. Orthop. Sci."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"730","DOI":"10.1016\/j.jocn.2014.10.025","article-title":"Endoscopic lumbar foraminotomy","volume":"22","author":"Evins","year":"2015","journal-title":"J. Clin. Neurosci."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1097\/01.BRS.0000050400.16499.ED","article-title":"Management of isthmic spondylolisthesis with posterolateral endoscopic foraminal decompression","volume":"28","author":"Knight","year":"2003","journal-title":"Spine"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Ahn, Y., Park, H.B., Yoo, B.R., and Jeong, T.S. (2022). Endoscopic lumbar foraminotomy for foraminal stenosis in stable spondylolisthesis. Front. Surg., 9.","DOI":"10.3389\/fsurg.2022.1042184"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"49","DOI":"10.2176\/nmc.oa.2017-0121","article-title":"Clinical and Radiological Outcomes of Microscopic Lumbar Foraminal Decompression: A Pilot Analysis of Possible Risk Factors for Restenosis","volume":"58","author":"Haimoto","year":"2018","journal-title":"Neurol. Med. Chir."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"947","DOI":"10.1007\/s00586-010-1597-1","article-title":"Clinical outcomes of microscopic decompression for degenerative lumbar foraminal stenosis: A comparison between patients with and without degenerative lumbar scoliosis","volume":"20","author":"Yamada","year":"2011","journal-title":"Eur. Spine J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"899","DOI":"10.14245\/ns.2346508.254","article-title":"Risk Factors of Restenosis After Full Endoscopic Foraminotomy for Lumbar Foraminal Stenosis: Case-Control Study","volume":"20","author":"Seo","year":"2023","journal-title":"Neurospine"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.2214\/AJR.09.2772","article-title":"A practical MRI grading system for lumbar foraminal stenosis","volume":"194","author":"Lee","year":"2010","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"465","DOI":"10.3340\/jkns.2016.1010.004","article-title":"Correlation between MRI Grading System and Surgical Findings for Lumbar Foraminal Stenosis","volume":"60","author":"Jeong","year":"2017","journal-title":"J. Korean Neurosurg. Soc."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1140","DOI":"10.1016\/j.clinimag.2016.07.005","article-title":"A clinically relevant MRI grading system for lumbar central canal stenosis","volume":"40","author":"Yuan","year":"2016","journal-title":"Clin. Imaging"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"72","DOI":"10.3171\/2009.7.SPINE09344","article-title":"Posterior decompression surgery for extraforaminal entrapment of the fifth lumbar spinal nerve at the lumbosacral junction","volume":"12","author":"Matsumoto","year":"2010","journal-title":"J. Neurosurg. Spine"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Rhee, D.Y., and Ahn, Y. (2022). Full-Endoscopic Lumbar Foraminotomy for Foraminal Stenosis in Spondylolisthesis: Two-Year Follow-Up Results. Diagnostics, 12.","DOI":"10.3390\/diagnostics12123152"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1055\/s-0031-1287774","article-title":"Prevention of development of postoperative dysesthesia in transforaminal percutaneous endoscopic lumbar discectomy for intracanalicular lumbar disc herniation: Floating retraction technique","volume":"54","author":"Cho","year":"2011","journal-title":"Minim. Invasive Neurosurg."},{"key":"ref_20","first-page":"57999","article-title":"A Mobile Outside-in Technique of Transforaminal Lumbar Endoscopy for Lumbar Disc Herniations","volume":"138","author":"Kim","year":"2018","journal-title":"J. Vis. Exp."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1016\/j.wneu.2019.07.005","article-title":"Percutaneous Endoscopic Transforaminal Outside-In Outside Technique for Foraminal and Extraforaminal Lumbar Disc Herniations-Operative Technique","volume":"130","author":"Fiorenza","year":"2019","journal-title":"World Neurosurg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1919","DOI":"10.1097\/BRS.0b013e3181d359bd","article-title":"Qualitative grading of severity of lumbar spinal stenosis based on the morphology of the dural sac on magnetic resonance images","volume":"35","author":"Schizas","year":"2010","journal-title":"Spine"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"324","DOI":"10.1097\/BSD.0b013e318149e681","article-title":"Clinical results of intrapedicular partial pediculectomy for lumbar foraminal stenosis","volume":"21","author":"Ozeki","year":"2008","journal-title":"J. Spinal Disord. Tech."},{"key":"ref_24","first-page":"264","article-title":"Microsurgical midline approach for the decompression of extraforaminal stenosis in L5-S1","volume":"98","author":"Park","year":"2003","journal-title":"J. Neurosurg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"88","DOI":"10.4103\/2152-7806.191024","article-title":"Contralateral interlaminar approach for intraforaminal lumbar degenerative disease with special emphasis on L5-S1 level: A technical note","volume":"7","author":"Zekaj","year":"2016","journal-title":"Surg. Neurol. Int."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"598","DOI":"10.2176\/nmc.oa.2021-0159","article-title":"Long-term Outcomes after Microsurgical Decompression of Lumbar Foraminal Stenosis and Adverse Effects of Preoperative Scoliosis: A Prospective Cohort Study","volume":"61","author":"Chang","year":"2021","journal-title":"Neurol. Med. Chir."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1016\/j.ebiom.2015.09.010","article-title":"Surgical Approaches to the Lumbar Hidden Zone: Current Strategies and Future Directions","volume":"2","author":"Reinshagen","year":"2015","journal-title":"eBioMedicine"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1097\/BSD.0b013e3182206dd3","article-title":"Efficacy of novel minimally invasive surgery using spinal microendoscope for treating extraforaminal stenosis at the lumbosacral junction","volume":"25","author":"Yamada","year":"2012","journal-title":"J. Spinal Disord. Tech."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1111\/os.12924","article-title":"Full-Endoscopic Foraminotomy with a Novel Large Endoscopic Trephine for Severe Degenerative Lumbar Foraminal Stenosis at L(5) S(1) Level: An Advanced Surgical Technique","volume":"13","author":"Song","year":"2021","journal-title":"Orthop. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1055\/s-2008-1052006","article-title":"Endoscopic laser foraminoplasty on the lumbar spine\u2014Early experience","volume":"41","author":"Knight","year":"1998","journal-title":"Minim. Invasive Neurosurg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1089\/104454701750285395","article-title":"Endoscopic foraminoplasty: A prospective study on 250 consecutive patients with independent evaluation","volume":"19","author":"Knight","year":"2001","journal-title":"J. Clin. Laser Med. Surg."},{"key":"ref_32","first-page":"320","article-title":"Posterolateral percutaneous endoscopic lumbar foraminotomy for L5-S1 foraminal or lateral exit zone stenosis. Technical note","volume":"99","author":"Ahn","year":"2003","journal-title":"J. Neurosurg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1007\/s00064-005-1156-9","article-title":"Endoscopic transforaminal nucleotomy with foraminoplasty for lumbar disk herniation","volume":"17","author":"Schubert","year":"2005","journal-title":"Oper. Orthop. Traumatol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1481","DOI":"10.1007\/s40122-021-00309-1","article-title":"Endoscopic Transforaminal Lumbar Foraminotomy: A Systematic Review and Meta-Analysis","volume":"10","author":"Giordan","year":"2021","journal-title":"Pain Ther."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"16","DOI":"10.3171\/2021.3.SPINE21206","article-title":"Transforaminal 360\u00b0 lumbar endoscopic foraminotomy in postfusion patients: Technical note and case series","volume":"36","author":"Telfeian","year":"2022","journal-title":"J. Neurosurg. Spine"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"595","DOI":"10.3171\/2009.2.SPINE08227","article-title":"Postoperative retroperitoneal hematoma following transforaminal percutaneous endoscopic lumbar discectomy","volume":"10","author":"Ahn","year":"2009","journal-title":"J. Neurosurg. Spine"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"192","DOI":"10.3340\/jkns.2009.45.3.192","article-title":"Huge Psoas Muscle Hematoma due to Lumbar Segmental Vessel Injury Following Percutaneous Endoscopic Lumbar Discectomy","volume":"45","author":"Kim","year":"2009","journal-title":"J. Korean Neurosurg. Soc."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1595","DOI":"10.1007\/s00586-015-4365-4","article-title":"Postoperative dysesthesia in minimally invasive transforaminal lumbar interbody fusion: A report of five cases","volume":"25","author":"Wang","year":"2016","journal-title":"Eur. Spine J."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e101","DOI":"10.1016\/j.wneu.2020.12.176","article-title":"Effect of Dorsal Root Ganglion Retraction in Endoscopic Lumbar Decompressive Surgery for Foraminal Pathology: A Retrospective Cohort Study of Interlaminar Contralateral Endoscopic Lumbar Foraminotomy and Discectomy versus Transforaminal Endoscopic Lumbar Foraminotomy and Discectomy","volume":"148","author":"Kim","year":"2021","journal-title":"World Neurosurg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"E831","DOI":"10.1097\/BRS.0000000000000917","article-title":"Adjacent Segment Disease After Posterior Lumbar Interbody Fusion: Based on Cases with a Minimum of 10 Years of Follow-up","volume":"40","author":"Nakashima","year":"2015","journal-title":"Spine"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e1081","DOI":"10.1097\/BRS.0000000000001568","article-title":"Association Between Lumbar Spine Sagittal Alignment and L4\u2013L5 Disc Degeneration Among Asymptomatic Young Adults","volume":"41","author":"Bonugli","year":"2016","journal-title":"Spine"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"E723","DOI":"10.1097\/BRS.0b013e31828f4e12","article-title":"Clinical and Radiological Outcomes of Microscopic Partial Pediculectomy for Degenerative Lumbar Foraminal Stenosis","volume":"38","author":"Yamada","year":"2013","journal-title":"Spine"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/10\/1299\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:38:00Z","timestamp":1760031480000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/10\/1299"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,21]]},"references-count":42,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2025,5]]}},"alternative-id":["diagnostics15101299"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15101299","relation":{},"ISSN":["2075-4418"],"issn-type":[{"type":"electronic","value":"2075-4418"}],"subject":[],"published":{"date-parts":[[2025,5,21]]}}}