Abstract

Background: Lumbar foraminal canal stenosis (LFS) is typically multifactorial: disk height loss and bulging, facet hypertrophy/osteophytes, ligamentous thickening, and post-inflammatory or post-interventional scarring. Methods: To develop and implement a structured system for surgical care in chronic vertebrogenic pain with radicular features attributable to LFS, integrating population-based MRI morphometrics and interventional therapy response profiling, we conducted a single-center, multi-cohort observational study to develop, operationalize, and internally evaluate a quantitative, volume-integrated diagnostic and treatment stratification framework for LFS. Results: A retrospective evaluation of 351 surgically treated patients (2017–2023) was performed to identify structural and clinical drivers of persistent or recurrent pain. Following selective blockades and radiofrequency denervation, radiculopathy regressed in 44.7% of patients, facet-mediated pain improved in 44.0%, and the median pain relief duration was 3–6 months. Oswestry Disability Index (ODI) dynamics after interventional therapy showed significant improvement at 6 months (all p < 0.001). Both groups demonstrated significant improvement in VAS, ODI, and SF-36 scores over time. Endoscopic decompression achieved faster early leg pain relief (VAS leg, p < 0.001 at 6 and 12 months). ALIF resulted in superior long-term back pain control (VAS back, p < 0.001 at 12 and 24 months). At 24 months, pain levels were clinically equivalent between groups, indicating that procedure selection influences pain profile rather than absolute outcome. Conclusions: By integrating quantitative foraminal volume, nerve occupancy, and segmental stability, we demonstrated that treatment success in LFS is not determined by the magnitude of decompression alone, but by the precision of phenotypic matching. Indirect decompression, endoscopic foraminotomy, microsurgical decompression, and fusion-based stabilization each have a rational role when aligned with the biomechanical context rather than applied reflexively.

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