SHORT-TERM CLINICAL OUTCOMES OF AWAKE AND OUTPATIENT TRANSFORAMINAL ENDOSCOPIC LUMBAR FORAMINOTOMY AND INTERSPINOUS SPACER DEVICE

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Abstract
Objective: To evaluate the clinical outcomes achieved with the combined surgical management of Transforaminal Endoscopic Lumbar Foraminoplasty (TELF) with an Interspinous Spacer Device (ISD) in patients with DS grades I and II and LSS. Methods: A retrospective observational study was conducted using clinical records of patients who underwent a TELF procedure plus the placement of an ISD for LSS and DS. Demographic variables and Patient-Reported Outcome Measures (PROMs), including the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI), were analyzed to evaluate the clinical outcomes of the combined procedures. A total of 37 patients (54.05% women, 45.95% men) were evaluated. The mean age was 59.59 ± 15.89 years (95% CI 55.29 – 64.89); 43.24% (n=16) of the sample were women aged 60 or older and 32.43% of the patients were “pensioner-retired.” The most common presenting symptom was radicular pain: 30.30% on the right side and 48.48% on the left side. A total of 49 TELF procedures were performed, and 45 ISD were placed in the 37 patients. The average procedure duration was 85.77 ± 28.54 minutes, and the average blood loss was 23.28 ± 21.96 ml. The most frequently operated level was L4-L5. Results: The VAS and ODI scores improved significantly differences (p <0.001) before and after the procedure. Two complications were observed (5.4%). The overall reoperation rate was 10.81% (n=4). Conclusion: Transforaminal endoscopic decompression with ISD represents a feasible and safe outpatient alternative for patients with low-grade spondylolisthesis and stenosis. This combined minimally invasive technique provides significant clinical improvement with a low reoperation rate and offers a compelling alternative to more invasive surgery. Level of Evidence IV; Case Series.

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