ArticleInternational journal of spine surgery2019
Use of "Inside-Out" Technique for Direct Visualization of a Vacuum Vertically Unstable Intervertebral Disc During Routine Lumbar Endoscopic Transforaminal Decompression-A Correlative Study of Clinical Outcomes and the Prognostic Value of Lumbar Radiographs.
Article in International journal of spine surgery, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed, 11 citations in OpenAlex.
- Transforaminal Endoscopic Lumbar Decompression: Defining Its Scope and Limitations.International journal of spine surgery · 2026Article
- An Evaluation of Lumbar Foraminal Stenosis Radiologic Grading Systems: A Systematic Review.Spine surgery and related research · 2026Review
- A Differential Clinical Benefit Examination of Full Lumbar Endoscopy vs Interspinous Process Spacers in the Treatment of Spinal Stenosis: An Effect Size Meta-Analysis of Clinical Outcomes.International journal of spine surgery · 2022Article
- Difficulties, Challenges, and the Learning Curve of Avoiding Complications in Lumbar Endoscopic Spine Surgery.International journal of spine surgery · 2021Article
- Artificial Intelligence Comparison of the Radiologist Report With Endoscopic Predictors of Successful Transforaminal Decompression for Painful Conditions of the Lumber Spine: Application of Deep Learning Algorithm Interpretation of Routine Lumbar Magnetic Resonance Imaging Scan.International journal of spine surgery · 2020Article
- Endoscopic Transforaminal Lumbar Interbody Fusion With a Single Oblique PEEK Cage and Posterior Supplemental Fixation.International journal of spine surgery · 2020Article
- Lumbar Endoscopic Bony and Soft Tissue Decompression With the Hybridized Inside-Out Approach: A Review And Technical Note.Neurospine · 2020Article
- Surgical outcomes of full endoscopic spinal surgery for lumbar disc herniation over a 10-year period: A retrospective study.PloS one · 2020Article
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Authors and funding
3 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe purpose of this study was to record the frequency of lumbar intervertebral disc vacuum phenomenon on routine lumbar plain films taken prior to transforaminal endoscopic decompression surgery for sciatica-type leg and back pain and to correlate it with visualized intradiscal pathology and clinical outcomes.
methodsA prospective case series study of 200 consecutive patients with an average mean follow-up of 41.85 months who underwent lumbar endoscopic transforaminal decompression at 236 lumbar levels was conducted. The sensitivity, specificity, and accuracy of vacuum phenomenon on preoperative x-ray to predict the presence of an empty vacuum disc found during transforaminal microdiscectomy using the "inside-out" approach were calculated using the YESS™ technique. Clinical outcomes were assessed by both Macnab criteria and visual analog score (VAS) reduction.
resultsOf the 200 patients evaluated, 124 (62%) were deemed to have a vacuum disc on intraoperative probing using the "inside-out" technique. During needle insertion the more severely degenerative discs are met with negative pressures manifested by an air discogram. According to Macnab criteria, all patients who also had extruded disc herniations had excellent results (8 of 200), with the mean VAS decreasing from 6.1 ± 2.6 preoperatively to 1.9 ± 1.4 at the final follow-up (
conclusionsA vacuum phenomenon seen on lumbar x-rays is highly specific for a source of one component that is actually a multiple source of nonspecific common back pain. A vacuum disc being found during "inside-out" transforaminal discectomy actually encompasses the disc, annulus, and foraminal stenosis as a multifactorial source of nonspecific common back pain. Further studies of better prognosticators of failed endoscopic transforaminal discectomy are required and are underway by the coauthors.
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