Clinical Efficacy of Extended Transforaminal Endoscopic Lumbar Foraminotomy Compared with the Conventional Technique

<b>Objectives</b>: Transforaminal endoscopic lumbar foraminotomy (TELF) is an emerging minimally invasive surgical technique for lumbar foraminal stenosis. However, its effectiveness is debated because of concerns regarding adequate decompression and its long-term consistency. This study introduced the extended form of TELF, an advanced technique, to provide more extensive decompression using the same approach. Thus, this study aimed to describe the surgical technique and clinical outcomes of this technique. <b>Methods</b>: This retrospective cohort study included patients who underwent conventional (<i>n</i> = 67) or extended (<i>n</i> = 64) TELF. The surgical procedure involved a transforaminal approach with endoscopic decompression, including the removal of the tip of the superior articular process, foraminal ligament, and ligamentum flavum (conventional group), or additional decompression, involving the isthmus and portions of the superior and inferior pedicle walls (extended group). Clinical outcomes were assessed using the visual analog pain scale, Oswestry disability index, and modified Macnab criteria. <b>Results</b>: Despite the longer surgical duration, the extended TELF group tended to show better outcomes in terms of the VAS and ODI scores at the early and final 2-year follow-ups (<i>p</i> < 0.05). The overall success rates were 92.19% and 85.07% in the extended and conventional groups, respectively. No difference was observed in surgical complications between the two groups. <b>Conclusions</b>: Extended TELF, a refined endoscopic technique, achieves better effects than conventional TELF with a lower risk of nerve root irritation by creating a sufficiently safe resection margin. The results support the use of an extended TELF as an advanced form of endoscopic foraminal decompression.