# Radiographic and clinical predictors of surgical outcomes following endoscopic decompression for radiculopathy in adult degenerative scoliosis: A multi-center retrospective study

## TL;DR

This study finds that endoscopic decompression can improve pain and function in adult scoliosis patients, with better outcomes linked to specific spinal measurements and pain patterns.

## Contribution

The study identifies radiographic and clinical predictors of successful outcomes after endoscopic decompression for radiculopathy in adult degenerative scoliosis.

## Key findings

- Lower preoperative Cobb angles and mild spinopelvic alignment correlate with better postoperative outcomes.
- Leg-dominant pain is associated with greater postoperative relief following endoscopic decompression.
- Severe spinal deformity or instability is linked to reduced success of the procedure.

## Abstract

Endoscopic transforaminal decompression is a minimally invasive approach for treating radiculopathy in adult degenerative scoliosis (ADS) secondary to foraminal stenosis. Previous research supports the feasibility and safety of this technique, but the correlation of preoperative measures with postoperative outcomes remains unclear.

This study aims to assess the efficacy of endoscopic decompression for ADS-related radiculopathy and identify predictive factors for postoperative pain and functionality to optimize surgical decision-making.

ADS patients with foraminal stenosis and radiculopathy undergoing endoscopic decompression with >6 month follow-up were retrospectively reviewed. Pre-operative spinopelvic measurements, demographics, and symptom predominance were collected and compared to post-operative clinical outcomes (Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores).

28 patients underwent endoscopic transforaminal decompression for primary radiculopathy or axial back pain. Mean preoperative ODI was 33 and VAS was 4.7 (back pain) and 6.1 (leg pain). Postoperatively, both VAS scores demonstrated significant improvement. Correlative analysis revealed that increasing deformity severity, measured by Cobb angle, pelvic incidence (PI) and central sacral cervical line (CSVL), was associated with poorer outcomes. Cobb angles from 18° to 25° and 26°- 52° were linked to worse postoperative pain and functional scores. Hyperlordosis (LL > 32°) similarly correlated with inferior outcomes. Conversely, PI values near physiologic range (47°-65°) were associated with greater postoperative functionality.

This study supports transforaminal endoscopic decompression as an effective treatment for radiculopathy and back pain in ADS. Lower preoperative Cobb angles and mild to moderate spinopelvic alignment yielded better postoperative outcomes. These findings may help guide surgical planning and predict success following endoscopic decompression.

•Transforaminal endoscopic decompression improves pain and function in ADS patients.•Favorable outcomes are present in patients with Cobb <26°, LL > 32°, PI 47°–65°.•Leg-dominant pain predicts greater postoperative relief.•Severe deformity/instability reduces decompression success.•Radiographic and clinical thresholds can guide patient selection and planning.

Transforaminal endoscopic decompression improves pain and function in ADS patients.

Favorable outcomes are present in patients with Cobb <26°, LL > 32°, PI 47°–65°.

Leg-dominant pain predicts greater postoperative relief.

Severe deformity/instability reduces decompression success.

Radiographic and clinical thresholds can guide patient selection and planning.