{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T21:10:26Z","timestamp":1788556226428,"version":"build-2803163510"},"reference-count":58,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2025,1,28]],"date-time":"2025-01-28T00:00:00Z","timestamp":1738022400000},"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: Lumbar spinal stenosis (LSS) remains a predominant cause of debilitating back and leg pain, affecting many aging populations. Traditional decompression surgeries can be invasive and pose significant risks and recovery time. This study elucidates the techniques and preliminary outcomes of endoscopic transfacet decompression in treating severe LSS. Methods: A retrospective review was performed on 65 patients with severe LSS who underwent endoscopic transfacet decompression. The patient outcomes were analyzed using the VAS for leg pain and the modified Macnab criteria. Pre-operative and post-operative scores were compared, and any complications were analyzed. An online survey was administered to 868 surgeons using Likert-scale ratings to evaluate surgeons\u2019 experience with endoscopic decompression in patients with painful spondylolisthesis. The survey responses were analyzed using descriptive statistics and Polytomous Rasch analysis to evaluate surgeon endorsement. Results: The study included 65 patients, of which 29 (44.6%) were female and 36 (55.4%) were male, with a mean age of 65.79 ranging from 38 to 84 years. The available mean post-operative follow-up period was 31.44 months, ranging from 24 to 39 months. The VAS score for leg pain reduced significantly from pre-operative 7.54 \u00b1 1.67 to 2.20 \u00b1 1.45 by 5.34 \u00b1 2.03 (p &lt; 0.001) with a large effect size (Cohen\u2019s d = 2.626). At the final follow-up, functional Macnab outcomes were reported as excellent by 20 (30.8%), good by 37 (56.9%), fair by 5 (7.7%), and poor by 3 (4.6%) of patients. There were no incidental durotomies, nerve root injuries, wound complications, or instances of post-operative instability. Only five patients (7.7%) developed post-operative dysesthesia. Incomplete decompression led to fair and poor outcomes in 8 (12.3%) patients. No revision surgeries were performed. post-operative instability was not observed. The surgeon survey corroborated these observations, where the polytomous Rasch analysis showed consensus on the effectiveness of the percutaneous endoscopic decompression of low-grade spondylolisthesis. Differential item functioning (DIF) analysis showed no significant bias in item responses between orthopaedic and neurosurgeons. Conclusions: The endoscopic transfacet decompression technique delineated herein showcased excellent Macnab outcomes in managing severe LSS, with a combined success rate of 87.7%. Patients also experienced a statistically significant reduction in leg pain. Dysesthesia rates were lower than with the transforaminal approach, likely because of limited exiting and traversing nerve root manipulation. This technique might represent a viable, less invasive alternative to open microsurgical dissection and decompression for patients with severe LSS, where fusion may be required. This approach was found to be highly accepted among endoscopic spine surgeons.<\/jats:p>","DOI":"10.3390\/jpm15020053","type":"journal-article","created":{"date-parts":[[2025,1,28]],"date-time":"2025-01-28T07:54:08Z","timestamp":1738050848000},"page":"53","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Endoscopic transfacet Decompression for Severe Lumbar Spinal Stenosis: A Technical Note, Illustrative Clinical Series, and Surgeon Survey Regarding Post-Decompression Instability"],"prefix":"10.3390","volume":"15","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, Division Personalized Pain Research and Education, Tucson, AZ 85712, USA"},{"name":"Department of Orthopaedic Surgery, University of Arizona, Tucson Campus, Tucson, AZ 85712, USA"},{"name":"Department of Orthopaedics, Fundaci\u00f3n Universitaria Sanitas, Bogot\u00e1 110111, Colombia"}],"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, Chille"},{"name":"Department of Orthopaedic Surgery, Faculdade de Medicina de Ribeir\u00e3o Preto (FMRP), Universidade de S\u00e3o Paulo (USP), Ribeir\u00e3o Preto 14040-900, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Choll","family":"Kim","sequence":"additional","affiliation":[{"name":"Excel Spine Center, Minimally Invasive Center of Excellence, UCSD Medical Center, East Campus, 6719 Alvarado Road, Suite 304, San Diego, CA 92120, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian","family":"Kwon","sequence":"additional","affiliation":[{"name":"New England Baptist Hospital, 125 Parker Hill Ave, Boston, MA 02120, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8077-3270","authenticated-orcid":false,"given":"John","family":"Ongulade","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Washington University, 660 South Euclid, Campus Box 8057, St. Louis, MO 63110, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenyu","family":"Ito","sequence":"additional","affiliation":[{"name":"Aichi Spine Institute, 41 Gohigashi, Takao, Fuso-cho, Niwa-gun, Aichi 480-0102, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paulo Sergio Terxeira","family":"de Carvalho","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Pain and Spine Minimally Invasive Surgery Service, Gaffree Guinle University Hospital, Rio de Janeiro, 20270-004, Brazil"}],"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"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"549","DOI":"10.3171\/2021.8.SPINE21890","article-title":"Endoscopic decompression for the treatment of lumbar spinal stenosis: An updated systematic review and meta-analysis","volume":"36","author":"Gaztanaga","year":"2022","journal-title":"J. Neurosurg. Spine"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"S21","DOI":"10.14444\/8161","article-title":"Difficulties, Challenges, and the Learning Curve of Avoiding Complications in Lumbar Endoscopic Spine Surgery","volume":"15","author":"Lewandrowski","year":"2021","journal-title":"Int. J. Spine Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1016\/j.wneu.2021.11.082","article-title":"Challenges in Spinal Endoscopy","volume":"160","author":"Hussain","year":"2022","journal-title":"World Neurosurg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/S1935-9810(07)70054-3","article-title":"The learning curve in foraminal endoscopic discectomy: Experience needed to achieve a 90% success rate","volume":"1","author":"Morgenstern","year":"2007","journal-title":"SAS J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1016\/j.spinee.2010.12.006","article-title":"An evaluation of the learning curve for a complex surgical technique: The full endoscopic interlaminar approach for lumbar disc herniations","volume":"11","author":"Wang","year":"2011","journal-title":"Spine J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1007\/s00586-012-2540-4","article-title":"Learning curve of full-endoscopic lumbar discectomy","volume":"22","author":"Hsu","year":"2013","journal-title":"Eur. Spine J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1987","DOI":"10.1016\/j.clineuro.2013.06.008","article-title":"Learning curve for percutaneous endoscopic lumbar discectomy depending on the surgeon\u2019s training level of minimally invasive spine surgery","volume":"115","author":"Wang","year":"2013","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e1007","DOI":"10.1016\/j.wneu.2018.10.197","article-title":"Learning Curve for Lumbar Decompressive Laminectomy in Biportal Endoscopic Spinal Surgery Using the Cumulative Summation Test for Learning Curve","volume":"122","author":"Park","year":"2019","journal-title":"World Neurosurg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1007\/s00701-019-04104-y","article-title":"How I do it? Interlaminar contralateral endoscopic lumbar foraminotomy assisted with the O-arm navigation","volume":"162","author":"Chen","year":"2020","journal-title":"Acta Neurochir."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"S197","DOI":"10.21037\/jss.2019.10.03","article-title":"Navigating the learning curve of spinal endoscopy as an established traditionally trained spine surgeon","volume":"6","author":"Ransom","year":"2020","journal-title":"J. Spine Surg."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Son, S., Ahn, Y., Lee, S.G., and Kim, W.K. (2020). Learning curve of percutaneous endoscopic interlaminar lumbar discectomy versus open lumbar microdiscectomy at the L5-S1 level. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0236296"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1055\/a-2029-2694","article-title":"Is Minimally Invasive Spinal Surgery (MISS) Superior to Endoscopic Spine Surgery in Post-operative Radiological Outcome for Lumbar Spine Degenerative Disease? A Systematic Review","volume":"85","author":"Patel","year":"2024","journal-title":"J. Neurol. Surg. A Cent. Eur. Neurosurg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1756","DOI":"10.1097\/BRS.0000000000002708","article-title":"Efficacy and Safety of Full-endoscopic Decompression via Interlaminar Approach for Central or Lateral Recess Spinal Stenosis of the Lumbar Spine: A Meta-analysis","volume":"43","author":"Lee","year":"2018","journal-title":"Spine"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Lee, C.W., Yoon, K.J., and Ha, S.S. (2019). Comparative Analysis between Three Different Lumbar Decompression Techniques (Microscopic, Tubular, and Endoscopic) in Lumbar Canal and Lateral Recess Stenosis: Preliminary Report. BioMed Res. Int., 2019.","DOI":"10.1155\/2019\/6078469"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1016\/j.asjsur.2019.08.010","article-title":"Using a percutaneous spinal endoscopy unilateral posterior interlaminar approach to perform bilateral decompression for patients with lumbar lateral recess stenosis","volume":"43","author":"Xin","year":"2019","journal-title":"Asian J. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"E168","DOI":"10.1093\/ons\/opaa360","article-title":"Hybrid Interlaminar Endoscopic Lumbar Decompression in Disc Herniation Combined With Spinal Stenosis","volume":"20","author":"Chen","year":"2021","journal-title":"Oper. Neurosurg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"447","DOI":"10.21037\/jss.2020.01.03","article-title":"Full endoscopic unilateral laminotomy for bilateral decompression of the cervical spine: Surgical technique and early experience","volume":"6","author":"Carr","year":"2020","journal-title":"J. Spine Surg."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Wu, P.H., Kim, H.S., Lee, Y.J., Kim, D.H., Lee, J.H., Jeon, J.B., Raorane, H.D., and Jang, I.T. (2020). Uniportal Full Endoscopic Posterolateral Transforaminal Lumbar Interbody Fusion with Endoscopic Disc Drilling Preparation Technique for Symptomatic Foraminal Stenosis Secondary to Severe Collapsed Disc Space: A Clinical and Computer Tomographic Study with Technical Note. Brain Sci., 10.","DOI":"10.3390\/brainsci10060373"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"334","DOI":"10.31616\/asj.2018.0210","article-title":"Biportal Endoscopic Spinal Surgery for Lumbar Spinal Stenosis","volume":"13","author":"Kim","year":"2019","journal-title":"Asian Spine J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"438","DOI":"10.21037\/jss.2020.03.08","article-title":"Unilateral biportal endoscopic decompression for degenerative lumbar canal stenosis","volume":"6","author":"Pao","year":"2020","journal-title":"J. Spine Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1016\/j.jor.2018.01.039","article-title":"Unilateral biportal endoscopic decompression by 30 degrees endoscopy in lumbar spinal stenosis: Technical note and preliminary report","volume":"15","author":"Kim","year":"2018","journal-title":"J. Orthop."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Kim, S.K., Kang, S.S., Hong, Y.H., Park, S.W., and Lee, S.C. (2018). Clinical comparison of unilateral biportal endoscopic technique versus open microdiscectomy for single-level lumbar discectomy: A multicenter, retrospective analysis. J. Orthop. Surg. Res., 13.","DOI":"10.1186\/s13018-018-0725-1"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1016\/j.wneu.2019.02.038","article-title":"A Systematic Review of Unilateral Biportal Endoscopic Spinal Surgery: Preliminary Clinical Results and Complications","volume":"125","author":"Lin","year":"2019","journal-title":"World Neurosurg."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Hua, W., Wang, B., Ke, W., Wu, X., Zhang, Y., Li, S., Yang, S., and Yang, C. (2020). Comparison of lumbar endoscopic unilateral laminotomy bilateral decompression and minimally invasive surgery transforaminal lumbar interbody fusion for one-level lumbar spinal stenosis. BMC Musculoskelet. Disord., 21.","DOI":"10.1186\/s12891-020-03820-2"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"S154","DOI":"10.14245\/ns.2040174.087","article-title":"The Technical Feasibility of Unilateral Biportal Endoscopic Decompression for The Unpredicted Complication Following Minimally Invasive Transforaminal Lumbar Interbody Fusion: Case Report","volume":"17","author":"Kim","year":"2020","journal-title":"Neurospine"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Sharma, S.B., Lin, G.X., Jabri, H., Siddappa, N.D., and Kim, J.S. (2020). Biportal Endoscopic Excision of Facetal Cyst in the Far Lateral Region of L5S1: 2-Dimensional Operative Video. Oper. Neurosurg., 18.","DOI":"10.1093\/ons\/opz255"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Lewandrowski, K.U., Dowling, A., Calderaro, A.L., Dos Santos, T.S., Bergamaschi, J.P.M., Leon, J.F.R., and Yeung, A. (2020). Dysethesia due to irritation of the dorsal root ganglion following lumbar transforaminal endoscopy: Analysis of frequency and contributing factors. Clin. Neurol. Neurosurg., 197.","DOI":"10.1016\/j.clineuro.2020.106073"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"280","DOI":"10.14444\/8038","article-title":"Dural Tears During Lumbar Spinal Endoscopy: Surgeon Skill, Training, Incidence, Risk Factors, and Management","volume":"15","author":"Lewandrowski","year":"2021","journal-title":"Int. J. Spine Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e371","DOI":"10.1016\/j.wneu.2022.11.019","article-title":"Complications of Unilateral Biportal Endoscopic Spinal Surgery for Lumbar Spinal Stenosis: A Meta-Analysis and Systematic Review","volume":"170","author":"Chen","year":"2023","journal-title":"World Neurosurg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1111\/os.13437","article-title":"Complications of Unilateral Biportal Endoscopic Spinal Surgery for Lumbar Spinal Stenosis: A Systematic Review of the Literature and Meta-analysis of Single-arm Studies","volume":"15","author":"Wang","year":"2023","journal-title":"Orthop. Surg."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Ahn, D.K., Lee, J.S., Shin, W.S., Kim, S., and Jung, J. (2021). post-operative spinal epidural hematoma in a biportal endoscopic spine surgery. Medicine, 100.","DOI":"10.1097\/MD.0000000000024685"},{"key":"ref_32","first-page":"3267","article-title":"[Characteristics and risk factors of spinal epidural hematoma after unilateral biportal endoscopic lumbar interbody fusion]","volume":"102","author":"Liang","year":"2022","journal-title":"Zhonghua Yi Xue Za Zhi"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"E221","DOI":"10.36076\/ppj.2017.E231","article-title":"Full-Endoscopic Assisted Lumbar Decompressive Surgery Performed in an Outpatient, Ambulatory Facility: Report of 5 Years of Complications and Risk Factors","volume":"20","author":"Kamson","year":"2017","journal-title":"Pain Physician"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1097\/BSD.0000000000001225","article-title":"Spine Surgery Complications in the Ambulatory Surgical Center Setting: Systematic Review","volume":"35","author":"Cha","year":"2022","journal-title":"Clin. Spine Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1007\/s00586-010-1493-8","article-title":"Dural tears in percutaneous endoscopic lumbar discectomy","volume":"20","author":"Ahn","year":"2011","journal-title":"Eur. Spine J."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1016\/j.wneu.2018.05.251","article-title":"Management of Dural Tears in Endoscopic Lumbar Spinal Surgery: A Review of the Literature","volume":"119","author":"Muller","year":"2018","journal-title":"World Neurosurg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1016\/j.wneu.2018.09.040","article-title":"Double-Layer TachoSil Packing for Management of Incidental Durotomy During Percutaneous Stenoscopic Lumbar Decompression","volume":"120","author":"Nam","year":"2018","journal-title":"World Neurosurg."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"544","DOI":"10.1007\/s00586-018-5637-6","article-title":"Iatrogenic dural tear in endoscopic lumbar spinal surgery: Full endoscopic dural suture repair (Youn\u2019s technique)","volume":"27","author":"Shin","year":"2018","journal-title":"Eur. Spine J."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e581","DOI":"10.1016\/j.wneu.2021.01.031","article-title":"Clinical Comparison of Unilateral Biportal Endoscopic Laminectomy versus Microendoscopic Laminectomy for Single-Level Laminectomy: A Single-Center, Retrospective Analysis","volume":"148","author":"Ito","year":"2021","journal-title":"World Neurosurg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"2726","DOI":"10.1007\/s00586-023-07620-9","article-title":"Ambulatory uniportal versus biportal endoscopic unilateral laminotomy with bilateral decompression for lumbar spinal stenosis-cohort study using a prospective registry","volume":"32","author":"Wu","year":"2023","journal-title":"Eur. Spine J."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"S34","DOI":"10.14245\/ns.2040160.080","article-title":"Lumbar Endoscopic Bony and Soft Tissue Decompression With the Hybridized Inside-Out Approach: A Review And Technical Note","volume":"17","author":"Lewandrowski","year":"2020","journal-title":"Neurospine"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.21037\/jss.2019.09.03","article-title":"Early and staged endoscopic management of common pain generators in the spine","volume":"6","author":"Yeung","year":"2020","journal-title":"J. Spine Surg."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Lewandrowski, K.U., Abraham, I., Ram\u00edrez Le\u00f3n, J.F., Telfeian, A.E., Lorio, M.P., Hellinger, S., Knight, M., De Carvalho, P.S.T., Ramos, M.R.F., and Dowling, \u00c1. (2022). A Proposed Personalized Spine Care Protocol (SpineScreen) to Treat Visualized Pain Generators: An Illustrative Study Comparing Clinical Outcomes and post-operative Reoperations between Targeted Endoscopic Lumbar Decompression Surgery, Minimally Invasive TLIF and Open Laminectomy. J. Pers. Med., 12.","DOI":"10.3390\/jpm12071065"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Lewandrowski, K.U., Yeung, A., Lorio, M.P., Yang, H., Ram\u00edrez Le\u00f3n, J.F., S\u00e1nchez, J.A.S., Fiorelli, R.K.A., Lim, K.T., Moyano, J., and Dowling, \u00c1. (2023). Personalized Interventional Surgery of the Lumbar Spine: A Perspective on Minimally Invasive and Neuroendoscopic Decompression for Spinal Stenosis. J. Pers. Med., 13.","DOI":"10.3390\/jpm13050710"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/j.clineuro.2018.07.015","article-title":"Successful outcome after outpatient transforaminal decompression for lumbar foraminal and lateral recess stenosis: The positive predictive value of diagnostic epidural steroid injection","volume":"173","author":"Lewandrowski","year":"2018","journal-title":"Clin. Neurol. Neurosurg."},{"key":"ref_46","first-page":"255","article-title":"Advances in endoscopic disc and spine surgery: Foraminal approach","volume":"11","author":"Yeung","year":"2003","journal-title":"Surg. Technol. Int."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"52","DOI":"10.14245\/ns.1938038.019","article-title":"Treatment of Soft Tissue and Bony Spinal Stenosis by a Visualized Endoscopic Transforaminal Technique Under Local Anesthesia","volume":"16","author":"Yeung","year":"2019","journal-title":"Neurospine"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"S19","DOI":"10.21037\/jss.2019.10.02","article-title":"Technology advancements in spinal endoscopy for staged management of painful spine conditions","volume":"6","author":"Tieber","year":"2020","journal-title":"J. Spine Surg."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Boone, W.J. (2016). Rasch analysis for instrument development: Why, when, and how?. CBE\u2014Life Sci. Educ., 15.","DOI":"10.1187\/cbe.16-04-0148"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1682\/JRRD.2004.02.0233","article-title":"Use of Rasch person-item map in exploratory data analysis: A clinical perspective","volume":"41","author":"Stelmack","year":"2004","journal-title":"J. Rehabil. Res. Dev."},{"key":"ref_51","first-page":"2526","article-title":"Rasch rating scale item estimates using maximum likelihood approach: Effects of sample size on the accuracy and bias of the estimates","volume":"29","author":"Azizan","year":"2020","journal-title":"Int. J. Adv. Sci. Technol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"111s","DOI":"10.1177\/2192568219887364","article-title":"AOSpine Consensus Paper on Nomenclature for Working-Channel Endoscopic Spinal Procedures","volume":"10","author":"Hofstetter","year":"2020","journal-title":"Glob. Spine J."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/j.jocn.2023.04.001","article-title":"Navigating the learning curve with large and giant tumors: Initial experience with endoscopic endonasal transphenoidal resection of PitNETs","volume":"112","author":"Balogun","year":"2023","journal-title":"J. Clin. Neurosci."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"2670","DOI":"10.1007\/s00586-023-07623-6","article-title":"Learning curve for endoscopic posterior cervical foraminotomy","volume":"32","author":"Perfetti","year":"2023","journal-title":"Eur. Spine J."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"E984","DOI":"10.1097\/BRS.0000000000003014","article-title":"Full-Endoscopic Visualized Foraminoplasty and Discectomy Under General Anesthesia in the Treatment of L4-L5 and L5-S1 Disc Herniation","volume":"44","author":"Hua","year":"2019","journal-title":"Spine"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"53","DOI":"10.14444\/6008","article-title":"Incidence, Management, and Cost of Complications After Transforaminal Endoscopic Decompression Surgery for Lumbar Foraminal and Lateral Recess Stenosis: A Value Proposition for Outpatient Ambulatory Surgery","volume":"13","author":"Lewandrowski","year":"2019","journal-title":"Int. J. Spine Surg."},{"key":"ref_57","first-page":"146","article-title":"Effects of unilateral endoscopic facetectomy on spinal stability","volume":"20","author":"Haufe","year":"2007","journal-title":"Clin. Spine Surg."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1129","DOI":"10.1007\/s00701-017-3186-0","article-title":"Clinical and radiological outcomes of endoscopic partial facetectomy for degenerative lumbar foraminal stenosis","volume":"159","author":"Youn","year":"2017","journal-title":"Acta Neurochir."}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/15\/2\/53\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T10:37:49Z","timestamp":1759919869000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/15\/2\/53"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,28]]},"references-count":58,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,2]]}},"alternative-id":["jpm15020053"],"URL":"https:\/\/doi.org\/10.3390\/jpm15020053","relation":{},"ISSN":["2075-4426"],"issn-type":[{"value":"2075-4426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,28]]}}}