This article reports a case series evaluating the short-term clinical outcomes of full-endoscopic disc cleaning (FEDC), which is one of the most minimally invasive surgical procedures for treating chronic low back pain (CLBP) due to Modic changes (MCs). Seven patients who underwent FEDC at Tokushima University Hospital between 2019 and 2021, with postoperative clinical outcomes available over a follow-up period of more than 12 months, were included in the study. Six men and one woman underwent FEDC. The average age of the patients was 48.7 years with an average CLBP duration of 9.4 years. Five of these patients showed favorable outcomes, with reductions in LBP. The other 2 required revision surgery at the 12-month follow-up due to recurrent symptoms. One of the patients who required revision surgery was the oldest in this series, a 73-year-old woman with mixed signal changes including Modic type 3 at the anterior corner at L2–3 to L4–5 levels with spinal malalignment. Although disc block was immediately effective, pain reproduction on discography yielded unclear results. The clinical outcomes of this series suggest that FEDC may be particularly effective for patients with inflammatory type 1 and type 2 changes and less advanced degenerative changes. However, in cases involving more complex degeneration, such as type 3 changes or notable spinal deformities, CLBP may arise from multiple contributing factors beyond MCs alone, underscoring the importance of a thorough evaluation when determining surgical indications for FEDC.

Transforaminal full-endoscopic lumbar surgery is widely accepted as a method of treating lumbar conditions, such as disc herniation, spinal stenosis, and lumbar foraminal stenosis (LFS). This minimally invasive approach, often performed under local anesthesia, is ideal for older patients and those with significant comorbidities. Full-endoscopic lumbar foraminotomy (FELF) has shown high success rates and notable symptom relief for LFS. However, complications including postoperative dysesthesia, dural tears, restenosis, and scoliosis progression, especially at L5–S1 due to extensive facet joint resection, remain challenges. In such cases, lumbar fusion may be more appropriate. A unique anatomical feature, the "lateral kissing spine," is characterized by contact between the L5 transverse process and the sacral ala. This feature appears to mitigate scoliosis progression, regardless of the preoperative Cobb angle or bone resection extent during FELF. We report two L5–S1 foraminal stenosis cases treated with FELF under local anesthesia: one with a lateral kissing spine, showing no scoliosis progression, and another without it, demonstrating significant progression. A review of 11 additional cases supports the protective role of the lateral kissing spine against scoliosis, even in cases with severe preoperative Cobb angles. This study reviews the complications of FELF, focusing on scoliosis progression, and proposes indications for FELF, highlighting the importance of the lateral kissing spine in surgical decision-making.

In the 2 decades or so since full-endoscopic spine surgery (FESS) was introduced, the procedure has advanced considerably. There are 2 major approaches of FESS, transforaminal (TF) and interlaminar. In this review article, we discuss the key strengths and merits of TF-FESS based on a literature search. First, the minimal invasiveness of the procedure allows for early return to work. Second, minimal invasiveness of the back muscles enables athletes to make a faster return to their previous competitive level. Third, the ability to perform TF-FESS under local anesthesia means it is suitable even in the elderly with poor general health.

Transforaminal full-endoscopic spine surgery (TF-FESS) is a minimally invasive surgical procedure that can be performed with only an 8-mm skin incision under local anesthesia. TF-FESS has been used to treat not only lumbar disc herniation, but also lumbar spinal stenosis. This paper describes transforaminal full-endoscopic lateral recess decompression. The best indication for this procedure is unilateral recess stenosis accompanied by transversing nerve root radiculopathy, with or without exiting nerve root radiculopathy. The skin entry point is about 6–8 cm from the midline, and the precise point is determined by preoperative planning. After local anesthesia, an 8-mm skin incision is made, and the cannula is placed on the surface of the superior articular process (SAP). Next, the SAP is resected from the pedicle to the tip using a high-speed drill to expose the facet joint space and flavum by the hand-down technique (gradually changing hand position to be downwards and moving the cannula inwards). After removing the flavum, the completely decompressed transversing nerve root can be clearly visualized and confirmed under fluoroscopy. Two hours postoperatively, patients can walk without restriction. Because this procedure requires the complete resection of the ventral side of the facet, it is also called full-endoscopic ventral facetectomy.