ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2026
UBE-TFD for lumbar foraminal stenosis and extreme lateral disc herniation: a preliminary case series of Doom's Point vs. pars interarticularis localization.
Article in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeTo compare the clinical efficacy, radiological outcomes, and safety of unilateral biportal endoscopic transforaminal foraminoplasty and discectomy (UBE-TFD) using a novel anatomical landmark ("Doom's Point," the transverse process-superior articular process [TP-SAP] confluence) versus conventional pars interarticularis localization for refractory lumbar foraminal stenosis (LFS) and extreme lateral disc herniation (ELDH).
methodsA retrospective analysis was conducted on 46 consecutive patients (Lee classification ≥ III for LFS/ELDH) who underwent UBE-TFD between March, 2023, and December, 2024. Patients were divided into two groups: 24 cases with Doom's point localization (Group A) and 22 cases with pars interarticularis localization (Group B). Perioperative parameters (operative time, intraoperative blood loss, fluoroscopy time, incision-to-spinous process midline distance), clinical outcomes (visual analog scale [VAS] for back/leg pain, Oswestry Disability Index [ODI]) at baseline and 1-year follow-up, radiological outcomes (foraminal area via 3D CT), and complications were recorded. Statistical analyses were performed using R software (Version 4.3.1) with paired t-tests, independent samples t-tests, and χ2/Fisher's exact tests (α = 0.05).
resultsBaseline characteristics were comparable between groups (all p > 0.05). Among perioperative parameters, Group A had a significantly larger incision-to-spinous process midline distance (7.9 ± 0.6 vs. 5.8 ± 0.5 cm, p < 0.001), while operative time (72.2 ± 15.5 vs. 80.5 ± 14.9 min, p = 0.421), intraoperative blood loss (47.9 ± 7.5 vs. 46.8 ± 7.1 mL, p = 0.563), and fluoroscopy time (9.2 ± 2.7 vs. 10.3 ± 3.1 s, p = 0.189) showed no significant differences between groups. At 1-year follow-up, both groups exhibited significant improvements in back/leg pain VAS and ODI scores compared with baseline (all p < 0.001), but Group A demonstrated superior clinical outcomes: lower leg pain VAS (1.1 ± 0.5 vs. 2.1 ± 0.8, p = 0.009) and ODI (10.1 ± 3.7% vs. 16.5 ± 4.6%, p = 0.007), alongside higher leg pain improvement rate (79.2 ± 7.6% vs. 60.9 ± 9.3%, p = 0.001) and function improvement rate (75.1 ± 7.0% vs. 57.8 ± 8.7%, p = 0.002). Radiologically, the foraminal area increase rate was significantly higher in Group A (83.1 ± 7.9% vs. 65.7 ± 8.0%, p = 0.002), correlating with its clinical benefits. In terms of safety, Group A had a more favorable profile: fewer cases of transient paresthesia (2 [8.3%] vs. 7 [31.8%], p = 0.017) and no exit nerve root injuries (0 [0%] vs. 3 [13.6%], p = 0.029). No major complications (e.g., dural tear, infection) or segmental instability were observed in either group. Furthermore, inter-observer consistency for Doom's Point localization was excellent (weighted Kappa = 0.89; intraclass correlation coefficient [ICC] = 0.92), confirming its reliability across surgeons of varying seniority.
conclusionsUBE-TFD demonstrates favorable short-term outcomes for selected foraminal pathologies. Larger prospective studies are warranted to validate these findings.
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