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

Introduction: 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. Research question: 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. Materials and methods: 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). Results: 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. Discussion and conclusion: 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.