{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,19]],"date-time":"2026-04-19T22:45:01Z","timestamp":1776638701114,"version":"3.51.2"},"reference-count":119,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2022,6,29]],"date-time":"2022-06-29T00:00:00Z","timestamp":1656460800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Background: Endoscopically visualized spine surgery has become an essential tool that aids in identifying and treating anatomical spine pathologies that are not well demonstrated by traditional advanced imaging, including MRI. These pathologies may be visualized during endoscopic lumbar decompression (ELD) and categorized into primary pain generators (PPG). Identifying these PPGs provides crucial information for a successful outcome with ELD and forms the basis for our proposed personalized spine care protocol (SpineScreen). Methods: a prospective study of 412 patients from 7 endoscopic practices consisting of 207 (50.2%) males and 205 (49.8%) females with an average age of 63.67 years and an average follow-up of 69.27 months was performed to compare the durability of targeted ELD based on validated primary pain generators versus image-based open lumbar laminectomy, and minimally invasive lumbar transforaminal interbody fusion (TLIF) using Kaplan-Meier median survival calculations. The serial time was determined as the interval between index surgery and when patients were censored for additional interventional and surgical treatments for low back-related symptoms. A control group was recruited from patients referred for a surgical consultation but declined interventional and surgical treatment and continued on medical care. Control group patients were censored when they crossed over into any surgical or interventional treatment group. Results: of the 412 study patients, 206 underwent ELD (50.0%), 61 laminectomy (14.8%), and 78 (18.9%) TLIF. There were 67 patients in the control group (16.3% of 412 patients). The most common surgical levels were L4\/5 (41.3%), L5\/S1 (25.0%), and L4-S1 (16.3%). At two-year f\/u, excellent and good Macnab outcomes were reported by 346 of the 412 study patients (84.0%). The VAS leg pain score reduction was 4.250 \u00b1 1.691 (p &lt; 0.001). No other treatment during the available follow-up was required in 60.7% (125\/206) of the ELD, 39.9% (31\/78) of the TLIF, and 19.7% (12\/61 of the laminectomy patients. In control patients, only 15 of the 67 (22.4%) control patients continued with conservative care until final follow-up, all of which had fair and poor functional Macnab outcomes. In patients with Excellent Macnab outcomes, the median durability was 62 months in ELD, 43 in TLIF, and 31 months in laminectomy patients (p &lt; 0.001). The overall survival time in control patients was eight months with a standard error of 0.942, a lower boundary of 6.154, and an upper boundary of 9.846 months. In patients with excellent Macnab outcomes, the median durability was 62 months in ELD, 43 in TLIF, and 31 months in laminectomy patients versus control patients at seven months (p &lt; 0.001). The most common new-onset symptom for censoring was dysesthesia ELD (9.4%; 20\/206), axial back pain in TLIF (25.6%;20\/78), and recurrent pain in laminectomy (65.6%; 40\/61) patients (p &lt; 0.001). Transforaminal epidural steroid injections were tried in 11.7% (24\/206) of ELD, 23.1% (18\/78) of TLIF, and 36.1% (22\/61) of the laminectomy patients. The secondary fusion rate among ELD patients was 8.8% (18\/206). Among TLIF patients, the most common additional treatments were revision fusion (19.2%; 15\/78) and multilevel rhizotomy (10.3%; 8\/78). Common follow-up procedures in laminectomy patients included revision laminectomy (16.4%; 10\/61), revision ELD (11.5%; 7\/61), and multilevel rhizotomy (11.5%; 7\/61). Control patients crossed over into ELD (13.4%), TLIF (13.4%), laminectomy (10.4%) and interventional treatment (40.3%) arms at high rates. Most control patients treated with spinal injections (55.5%) had excellent and good functional outcomes versus 40.7% with fair and poor (3.7%), respectively. The control patients (93.3%) who remained in medical management without surgery or interventional care (14\/67) had the worst functional outcomes and were rated as fair and poor. Conclusions: clinical outcomes were more favorable with lumbar surgeries than with non-surgical control groups. Of the control patients, the crossover rate into interventional and surgical care was 40.3% and 37.2%, respectively. There are longer symptom-free intervals after targeted ELD than with TLIF or laminectomy. Additional intervention and surgical treatments are more often needed to manage new-onset postoperative symptoms in TLIF- and laminectomy compared to ELD patients. Few ELD patients will require fusion in the future. Considering the rising cost of surgical spine care, we offer SpineScreen as a simplified and less costly alternative to traditional image-based care models by focusing on primary pain generators rather than image-based criteria derived from the preoperative lumbar MRI scan.<\/jats:p>","DOI":"10.3390\/jpm12071065","type":"journal-article","created":{"date-parts":[[2022,6,29]],"date-time":"2022-06-29T22:43:28Z","timestamp":1656542608000},"page":"1065","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["A Proposed Personalized Spine Care Protocol (SpineScreen) to Treat Visualized Pain Generators: An Illustrative Study Comparing Clinical Outcomes and Postoperative Reoperations between Targeted Endoscopic Lumbar Decompression Surgery, Minimally Invasive TLIF and Open Laminectomy"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7842-2914","authenticated-orcid":false,"given":"Kai-Uwe","family":"Lewandrowski","sequence":"first","affiliation":[{"name":"Fundaci\u00f3n Universitaria Sanitas, Cl\u00ednica Reina Sof\u00eda-Cl\u00ednica Colsanitas, Centro de Columna-Cirug\u00eda M\u00ednima Invasiva, Bogot\u00e1 104-76, D.C., Colombia"},{"name":"The Federal University of the State of Rio de Janeiro UNIRIO, Pain and Spine Minimally Invasive Surgery Service at Gaffr\u00e9e Guinle University Hospital HUGG, Tijuca, Rio de Janeiro 20270-004 RJ, Brazil"},{"name":"Center for Advanced Spine Care of Southern Arizona and Surgical Institute of Tucson, Tucson, AZ 85712, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5224-4977","authenticated-orcid":false,"given":"Ivo","family":"Abraham","sequence":"additional","affiliation":[{"name":"Pharmacy Practice and Science, Family and Community Medicine, Clinical Translational Sciences at the University of Arizona, Roy P. Drachman Hall, Rm. B306H, Tucson, AZ 85721, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jorge Felipe","family":"Ram\u00edrez Le\u00f3n","sequence":"additional","affiliation":[{"name":"Minimally Invasive Spine Center Bogot\u00e1 D.C. Colombia, Reina Sof\u00eda Clinic Bogot\u00e1 D.C. Colombia, Department of Orthopaedics Fundaci\u00f3n Universitaria Sanitas, Bogot\u00e1 104-76, D.C., Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Albert E.","family":"Telfeian","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI 12321, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Morgan P.","family":"Lorio","sequence":"additional","affiliation":[{"name":"Advanced Orthopedics, 499 East Central Parkway, Altamonte Springs, FL 32701, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefan","family":"Hellinger","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Arabellaklinik, 81925 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Knight","sequence":"additional","affiliation":[{"name":"The Weymouth Hospital, 42-46 Weymouth Street London, 27 Harley Street, London W1G 9QP, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paulo S\u00e9rgio Teixeira","family":"De Carvalho","sequence":"additional","affiliation":[{"name":"Pain and Spine Minimally Invasive Surgery Service at Gaffre e Guinle University Hospital, Rio de Janeiro 20270-004 RJ, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Max Rog\u00e9rio Freitas","family":"Ramos","sequence":"additional","affiliation":[{"name":"Orthopedic Clinics at Gaffr\u00e9e Guinle University Hospital HUGG, Rio de Janeiro 20270-004 RJ, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"\u00c1lvaro","family":"Dowling","sequence":"additional","affiliation":[{"name":"Orthopaedic Spine Surgeon, Director of Endoscopic Spine Clinic, Santiago 8330024, Chile"},{"name":"Department of Orthopaedic Surgery, USP, Ribeir\u00e3o Preto 14049-900 SP, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manuel","family":"Rodriguez Garcia","sequence":"additional","affiliation":[{"name":"Spine Clinic, The American-Bitish Cowdray Medical Center I.A.P. Campus Santa Fe, M\u00e9xico City 87501, Mexico"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fauziyya","family":"Muhammad","sequence":"additional","affiliation":[{"name":"Society for Brain Mapping and Therapeutics (SBMT), Los Angeles, CA 90272, USA"},{"name":"Brain Mapping Foundation (BMF), Los Angeles, CA 90272, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Namath","family":"Hussain","sequence":"additional","affiliation":[{"name":"Society for Brain Mapping and Therapeutics (SBMT), Los Angeles, CA 90272, USA"},{"name":"Department of Neurosurgery, Loma Linda University, Loma Linda, CA 90272, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vicky","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Society for Brain Mapping and Therapeutics (SBMT), Los Angeles, CA 90272, USA"},{"name":"Brain Mapping Foundation (BMF), Los Angeles, CA 90272, USA"},{"name":"USC-Norris Comprehensive Cancer Center, USC-Keck School of Medicine, Los Angeles, CA 90033, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Babak","family":"Kateb","sequence":"additional","affiliation":[{"name":"Society for Brain Mapping and Therapeutics (SBMT), Los Angeles, CA 90272, USA"},{"name":"Brain Mapping Foundation (BMF), Los Angeles, CA 90272, USA"},{"name":"Middle East Brain + Initiative, Los Angeles, CA 90272, USA"},{"name":"National Center for Nanobioelectronics, Los Angeles, CA 90272, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony","family":"Yeung","sequence":"additional","affiliation":[{"name":"Desert Institute for Spine Care, Phoenix, AZ 85058, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,6,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.clineuro.2019.02.019","article-title":"Retrospective analysis of accuracy and positive predictive value of preoperative lumbar MRI grading after successful outcome following outpatient endoscopic decompression for lumbar foraminal and lateral recess stenosis","volume":"179","author":"Lewandrowski","year":"2019","journal-title":"Clin. 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