Endoscopic Foraminotomy for the Treatment of Lumbar Neuro-Foramen Stenosis: Role of CT in Treatment Planning and Post-Operative Assessment

Abstract

Purpose: to outline the role of CT in pre- and post-treatment evaluation in the case of lumbar endoscopic foraminotomy. Methods: This prospective study, conducted between September 2020 and January 2024, included consecutive patients with clinical symptoms of lumbar sciatica/lumbalgia/lombo-cruralgia/lower limb peripheral neuropathy. Pre- and post-foraminotomy CT imaging was used to assess the foraminal diameters (cranio-caudal, transverse and free hand ROI area) before and after the treatment. Two independent blinded readers assessed the CT randomly. VAS pain scale and the measurements of each foramen were compared before and after treatment. Interobserver agreement was assessed using the Intraclass Correlation Coefficient (ICC). Results: A total of 47 participants were enrolled, with 53 intervertebral levels analyzed. The mean VAS value decreased from 9.17 in the preoperative period to 0.66 at the one-month postoperative follow-up. The clinical response was associated with statistically significant changes in the cranio-caudal and transverse diameters, as well as the area of the treated neuroforamina (p-values < 0.05). Inter-rater reliability between the two operators ranged from 0.75 to 0.90. Conclusions: CT can demonstrate a significant enlargement of the neuroforaminal diameters after the endoscopic foraminotomy, with good correlation with clinical improvement.

Keywords

• CT
• foraminotomy
• treatment planning
• measurement