Transforaminal Endoscopic Surgery: Its Role in the Treatment of Painful Conditions of an Aging Spine

A major gap exists between fusion oriented surgeons and Pain Management leaders, bridged by transforaminal endoscopic surgeons represented by the International Intradiscal and Transforaminal Therapy Society (formerly IITS). Current surgical philosophy by key opinion leaders (KOL’s) focus on attaining fusion of the painful spinal segment by emphasizing femoral-pelvic and overall spine sagittal alignment, representing another phase in the evolution of fusion techniques. For pain management, Neuro Modulation of the Spinal Cord and more recently, the Dorsal Root Ganglion is the area of focus as represented by the key opinion leaders, Gabor Racz and the World Institute of Pain (WIP). Endoscopic surgeons support “full endoscopic” decompression procedures as the least invasive of the trend toward minimally invasiveness in spine surgery. Notably, transforaminal decompression is still under-valued and under-utilized because formal training in academic centers is lacking, and since advancements have been made in private practice settings.