{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T22:07:59Z","timestamp":1790892479715,"version":"4.1.0"},"reference-count":83,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2023,4,23]],"date-time":"2023-04-23T00:00:00Z","timestamp":1682208000000},"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>Pain generator-based lumbar spinal decompression surgery is the backbone of modern spine care. In contrast to traditional image-based medical necessity criteria for spinal surgery, assessing the severity of neural element encroachment, instability, and deformity, staged management of common painful degenerative lumbar spine conditions is likely to be more durable and cost-effective. Targeting validated pain generators can be accomplished with simplified decompression procedures associated with lower perioperative complications and long-term revision rates. In this perspective article, the authors summarize the current concepts of successful management of spinal stenosis patients with modern transforaminal endoscopic and translaminar minimally invasive spinal surgery techniques. They represent the consensus statements of 14 international surgeon societies, who have worked in collaborative teams in an open peer-review model based on a systematic review of the existing literature and grading the strength of its clinical evidence. The authors found that personalized clinical care protocols for lumbar spinal stenosis rooted in validated pain generators can successfully treat most patients with sciatica-type back and leg pain including those who fail to meet traditional image-based medical necessity criteria for surgery since nearly half of the surgically treated pain generators are not shown on the preoperative MRI scan. Common pain generators in the lumbar spine include (a) an inflamed disc, (b) an inflamed nerve, (c) a hypervascular scar, (d) a hypertrophied superior articular process (SAP) and ligamentum flavum, (e) a tender capsule, (f) an impacting facet margin, (g) a superior foraminal facet osteophyte and cyst, (h) a superior foraminal ligament impingement, (i) a hidden shoulder osteophyte. The position of the key opinion authors of the perspective article is that further clinical research will continue to validate pain generator-based treatment protocols for lumbar spinal stenosis. The endoscopic technology platform enables spine surgeons to directly visualize pain generators, forming the basis for more simplified targeted surgical pain management therapies. Limitations of this care model are dictated by appropriate patient selection and mastering the learning curve of modern MIS procedures. Decompensated deformity and instability will likely continue to be treated with open corrective surgery. Vertically integrated outpatient spine care programs are the most suitable setting for executing such pain generator-focused programs.<\/jats:p>","DOI":"10.3390\/jpm13050710","type":"journal-article","created":{"date-parts":[[2023,4,24]],"date-time":"2023-04-24T03:38:07Z","timestamp":1682307487000},"page":"710","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Personalized Interventional Surgery of the Lumbar Spine: A Perspective on Minimally Invasive and Neuroendoscopic Decompression for Spinal Stenosis"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7842-2914","authenticated-orcid":false,"given":"Kai-Uwe","family":"Lewandrowski","sequence":"first","affiliation":[{"name":"Center for Advanced Spine Care of Southern Arizona, Tucson, AZ 85712, USA"},{"name":"Department of Orthopaedics, Fundaci\u00f3n Universitaria Sanitas, Bogot\u00e1 111321, Colombia"},{"name":"Department of Orthopedics at Hospital Universit\u00e1rio Gaffree Guinle Universidade Federal do Estado do Rio de Janeiro, R. Mariz e Barros, 775-Maracan\u00e3, Rio de Janeiro 20270-004, Brazil"},{"name":"Brain Technology and Innovation Park, Pacific Palisades, CA 90272, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Yeung","sequence":"additional","affiliation":[{"name":"Desert Institute for Spine Care, 1635 E Myrtle Ave Suite 400, Phoenix, AZ 85020, USA"},{"name":"Department of Neurosurgery, University of New Mexico School of Medicine, 915 Camino de Salud NE Albuquerque, Albuquerque, NM 87106, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morgan P.","family":"Lorio","sequence":"additional","affiliation":[{"name":"Advanced Orthopedics, 499 East Central Parkway, Altamonte Springs, FL 32701, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huilin","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, No. 899 Pinghai Road, Suzhou 215031, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge Felipe","family":"Ram\u00edrez Le\u00f3n","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Fundaci\u00f3n Universitaria Sanitas, Bogot\u00e1 111321, Colombia"},{"name":"Minimally Invasive Spine Center Bogot\u00e1 D.C. Colombia, Reina Sof\u00eda Clinic Bogot\u00e1 D.C. Colombia, Bogot\u00e1 110141, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 Antonio Soriano","family":"S\u00e1nchez","sequence":"additional","affiliation":[{"name":"Spine Clinic, The American-Bitish Cowdray Medical Center I.A.P, Campus Santa Fe, Mexico City 05370, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rossano Kepler Alvim","family":"Fiorelli","sequence":"additional","affiliation":[{"name":"Department of General and Specialized Surgery, Gaffr\u00e9e e Guinle University Hospital, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro 20000-000, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kang Taek","family":"Lim","sequence":"additional","affiliation":[{"name":"Good Doctor Teun Teun Spine Hospital, Seoul 775 , Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaime","family":"Moyano","sequence":"additional","affiliation":[{"name":"Torres M\u00e9dicas Hospital Metropolitano, San Gabriel y Nicol\u00e1s Arteta Torre M\u00e9dica 3, Piso 5, Quito 170521, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00c1lvaro","family":"Dowling","sequence":"additional","affiliation":[{"name":"DWS Spine Clinic Center, CENTRO EL ALBA-Cam. El Alba 9500, Of. A402, Regi\u00f3n Metropolitana, Las Condes 9550000, Chile"},{"name":"Department of Orthopaedic Surgery, Faculdade de Medicina de Ribeir\u00e3o Preto (FMRP) da Universidade de S\u00e3o Paulo (USP), Ribeir\u00e3o Preto 14040-900, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan Marcelo","family":"Sea Aramayo","sequence":"additional","affiliation":[{"name":"Hospital Obrero N\u00b01, C. Lucas Jaimes 76, La Paz 0201-0220, Bolivia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeong-Yoon","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 731, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5361-5234","authenticated-orcid":false,"given":"Hyeun-Sung","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Nanoori Hospital Gangnam Hospital, Seoul 731, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiancheng","family":"Zeng","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, West China Hospital Sichuan University, Chengdu 610041, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Meng","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou 215005, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando Alvarado","family":"G\u00f3mez","sequence":"additional","affiliation":[{"name":"Santa Fe Foundation and Instituto Roosevelt, Bogot\u00e1 110311, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolina","family":"Ramirez","sequence":"additional","affiliation":[{"name":"Centro de Cirug\u00eda M\u00ednima Invasiva\u2014CECIMIN, Avenida Carrera 45 # 104\u201376, Bogot\u00e1 0819, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paulo S\u00e9rgio Teixeira","family":"De Carvalho","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Pain and Spine Minimally Invasive Surgery Service at Gaffree Guinle 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Bolivia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Meves","sequence":"additional","affiliation":[{"name":"Santa Casa Spine Center, S\u00e3o Paulo 09015-000, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristiano M.","family":"Menezes","sequence":"additional","affiliation":[{"name":"Universidade Federal de Minas Gerais (UFMG), Belo Horizonte 31270-901, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis Eduardo","family":"Carelli","sequence":"additional","affiliation":[{"name":"Instituto Nacional Traumato-Ortopedia-INTO, Rio de Janeiro 20940-070, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7797-5274","authenticated-orcid":false,"given":"Alexandre Foga\u00e7a","family":"Cristante","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of S\u00e3o Paulo (USP), S\u00e3o Paulo 05508-060, 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