Patient Perspectives on Awake Transforaminal Endoscopic Decompression Surgery Outcomes

Survey Patients and Demographics

The patient survey focusing on outcomes and satisfaction following endoscopic transforaminal surgery resulted in 102 completed responses, which comprised the final dataset. Respondents took an average of 8 minutes and 9 seconds to finish the survey. Participants had a mean (SD) age of 68.1 (13.0) years (range, 27.0 to 89.0 years). Among these patients, 60.8% were men and 39.2% were women. The mean duration of symptoms before surgery was around 30.0 months, although some patients experienced symptoms for 120.0 months or more. Before surgery, 59.8% of the patients (61 of 102) were employed, and a notable 78.7% of those (48 of 61) returned to work after surgery.

Surgical Outcomes and Patient Satisfaction

The survey results show that surgical outcomes were generally positive, with an average satisfaction rating of 4.3. Specifically, 57.8% of respondents reported that their expectations were fully met, while 15.7% rated them as a 4, 13.7% as a 3, 5.9% as a 2, and 6.9% as not met at all. Regarding the need for additional care after surgery, 61.8% of participants were fully satisfied, giving the experience an average rating of 4.3. Additionally, 17.6% rated their satisfaction as a 4, 10.8% as a 3, 5.9% as a 2, and 3.9% as not satisfied. In terms of quality-of-life improvement due to reduced postsurgical pain, 50% felt fully improved, with an average score of 4.1. The breakdown further reveals that 17.6% rated their improvement as a 4, 18.6% as a 3, 7.8% as a 2, and 5.9% as not improved. Lastly, experiences during recovery regarding pain or discomfort varied. The average discomfort rating was 3.5, with 23.5% experiencing no pain at all (5), 29.4% rating it as a 4, 24.5% as a 3, 13.7% as a 2, and 8.8% as very painful (1). These results indicate a largely favorable response to the surgical processes and subsequent recovery experiences (Figure 1).

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Figure 1

Perceptions of surgical outcomes and recovery after awake transforaminal endoscopic decompression. This figure illustrates responses from 102 patients on the extent to which surgical outcomes met expectations. The mean satisfaction rating was 4.3, mean satisfaction with the need for additional postsurgical care was 4.3, mean impact of reduced pain on quality of lifewas 4.1, and mean the level of pain experienced during recovery of 3.5.

Recovery Experience and Procedure Impact Assessment

The survey results for the recovery process indicated a mean pain or discomfort rating of 3.5. Among the respondents, 23.5% reported no pain at all, while 29.4% rated their discomfort as a 4, 24.5% as a 3, 13.7% as a 2, and 8.8% as very painful. When evaluating the endoscopic procedure’s impact on overall well-being, respondents gave an average score of 4.1, with 51% indicating that it completely turned their lives around. Further breakdown shows 16.7% rated it as a 4, 17.6% as a 3, 8.8% as a 2, and 5.9% as having no impact. When asked about recommending the procedure to others with similar conditions, the mean likelihood rating was 4.5. A significant 72.5% of participants were very likely to recommend it, with 12.7% rating it as a 4, 7.8% as a 3, 4.9% as a 2, and 2% as not likely. Regarding the thoroughness of the surgeon’s explanation of expected outcomes, the average score was 4.7, with 82.4% feeling expected outcomes were well explained. In addition, 9.8% rated the explanation as a 4, 5.9% as a 3, 2% as a 2, and no respondent rated the explanations as inadequate. These responses generally reflect positive experiences and satisfaction levels with the procedure and the communication involved (Figure 2).

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Figure 2

Assessment of recovery and procedural impact after awake transforaminal endoscopic decompression. This figure presents data from 102 respondents regarding pain and discomfort during recovery, with a mean score of 3.5. The impact of the endoscopic procedure on overall well-being had a mean rating of 4.1. The mean likelihood of recommending the procedure to others was 4.5, and the thoroughness of the surgeon’s explanation of expected outcomes was rated highly at 4.7.

Patient Perspectives on Surgical Outcomes and Symptom Management

The survey responses also offered a comprehensive view of the participants’ experiences regarding how surgical outcomes matched with preoperative explanations: 65.7% (67 individuals) felt they were as explained, with a mean rating of 4.3. Pain medication usage varied, with 37.3% (38 respondents) never needing it, averaging a score of 3.4. Meanwhile, 21.6% (22 respondents) required it daily. To manage unresolved symptoms, 32.3% (30 out of 93) frequently used anti-inflammatories and 61.8% (58) relied on prescription painkillers. Physical therapy and chiropractic care were reported by 55.8% (52) and 71.8% (67) respectively, while acupuncture and yoga saw engagement from 77.6% (72) and 72.4% (69). When comparing endoscopic surgery to traditional methods, 58.4% (52 out of 89) strongly agreed that it offers better outcomes, with 14.6% (13) agreeing and 16.9% (15) neutral. Only 6.7% (6) strongly disagree, and 3.4% (3) expressed other views, with none disagreeing outright, highlighting significant confidence in endoscopic procedures (Figure 3).

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Figure 3

Evaluations of surgical outcomes and symptom management after awake transforaminal endoscopic decompression. This figure presents data from 102 respondents, showing how surgical results aligned with explanations (mean rating of 4.3) and pain medication usage frequencies (mean rating of 3.4). It also details the utilization of various treatments like anti-inflammatories, prescription painkillers, physical therapy, and chiropractic care among 93 respondents. Additionally, it reflects opinions on endoscopic vs traditional spine surgery from 89 respondents, with a majority strongly agreeing on better outcomes with endoscopic methods.

Unsolicited Patient Comments

The feedback on endoscopic spine surgery highlights a range of experiences from patients. Many appreciated the quicker recovery and reduced pain compared with traditional surgeries. Several described significant relief and satisfaction, with some noting immediate improvement and others finding the procedure life changing. The primary surgeon received frequent praise for his expertise and compassion, with patients expressing gratitude for his minimally invasive approach. However, some reported ongoing pain, complications, or less effective results, necessitating further treatment. Despite these issues, many patients would recommend the procedure and the surgeon, noting improvements in mobility and daily life. While some faced challenges like nerve damage and unexpected outcomes, the overall sentiment was positive, with many considering the procedure a valuable alternative to more invasive surgeries. The following list provides some examples of patient feedback on endoscopic surgery:

• Recovery was significantly quicker, and pain was much lower compared with traditional surgery.

• “The surgeon was very kind and helpful. It is still a work in progress.”

• Immediate results with recovery time in days, not months.

• “I feel another trial with this procedure would be helpful.”

• “The surgery worked exactly as promised, allowing me to resume normal activities.”

• Ongoing pain led to further surgery but praised the initial procedure’s quality.

• “Feeling awesome and very satisfied with the outcome.”

• Some pain returned weeks later but markedly less than before surgery.

• Gratitude was expressed toward Dr. Telfeian for his care and expertise.

• “The endoscopic surgery was life changing, allowing me to enjoy life again.”

Rasch Analysis

The Rasch analysis provides insights into the fit and effectiveness of a series of survey items. The model fit reveals a person reliability of 0.739, indicating moderate consistency in responses, while the MADaQ3 value of 0.170 and a significant P value (<0.001) suggest a good fit to the Rasch model. Comparing models, the partial credit model (PCM) has a log-likelihood of −671 and deviance of 1342, with an Akaike information criterion of 1400 and a Bayesian information criterion of 1476, across 29 parameters for 102 respondents. The rating scale model is slightly simpler with 11 parameters, showing a log-likelihood of −683 and deviance of 1366. While PCM offers a marginally better fit due to its complexity, both models adequately describe the data. The Q3 Correlation Matrix highlights correlations among items, with notable positive correlations such as 0.517 between “To what extent did the surgical outcome meet your expectations?” (A) and “To what extent did the reduction in pain postsurgery improve your quality of life?” (C), indicating that expectations and quality of life improvements are related. Conversely, “How much pain or discomfort did you experience during the recovery process?” (D) shows negative correlations with several items, such as −0.499 with “To what extent did the surgical outcome meet your expectations?” (A), suggesting that individual experiences of pain during recovery were impacted by other aspects. The Q3 Correlation Matrix shows several negative correlations, indicating inverse relationships between items. These included the item “How satisfied were you with the need for additional care, such as seeing other doctors or utilizing other services after surgery?” (B) and “To what extent did the reduction in pain postsurgery improve your quality of life?” (C): −0.103; or “To what extent did the reduction in pain postsurgery improve your quality of life?” (C): −0.527; and “How would you rate the endoscopic procedure turning your life around and its impact on your overall well-being?” (E); and other items such as “How much pain or discomfort did you experience during the recovery process?” (D): −0.235. These negative correlations suggest that as the experience of positive outcomes or satisfaction increases, the perceived need for additional care or reported discomfort decreases.

Item statistics demonstrated varied difficulty levels and fit statistics. “To what extent did the surgical outcome meet your expectations?” (A) and “To what extent did the reduction in pain postsurgery improve your quality of life?” (C) have low outfit values, suggesting good response predictability, while “How satisfied were you with the need for additional care, such as seeing other doctors or utilizing other services after surgery?” (B), “How much pain or discomfort did you experience during the recovery process?” (D), and “How thoroughly did your surgeon explain the expected outcomes of the surgery?” (G) displayed higher outfit values, indicating unexpected responses from some individuals. In delta-tau parameterization, “How thoroughly did your surgeon explain the expected outcomes of the surgery?” (G) exhibits extreme values, implying issues with respondent differentiation. This aligns with its Thurstone thresholds, which show a wide range from −12.00 to −2.034, indicating divergence in perceived difficulty. The analysis suggests a generally good fit for the model, with some items not meeting patients’ expectations. Table 1 summarizes the survey items with their respective measures, fit statistics, and patient agreement strength, which prioritizes the survey items from the strongest to the weakest patient agreement.

These findings are graphically depicted in the person-item map, which provides a comprehensive view of patients’ perceptions and the level of agreement (item difficulties), reflecting the findings from the previous analyses (Figure 4). The distribution of respondents’ partial agreement is clustered toward the middle, suggesting most participants have moderate agreement levels regarding their experiences and expectations related to the surgery. The item thresholds reveal different difficulty levels for each survey item. “To what extent did the surgical outcome meet your expectations?” (A) shows moderate difficulty, aligning with the general notion that expectations were largely met. Items such as “How satisfied were you with the need for additional care?” (B) and “How much pain or discomfort did you experience during the recovery process?” (D) vary more significantly, reflecting diverse experiences as supported by the higher outfit statistics and noted negative correlations.

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Figure 4

The person-item map illustrates the distribution of patients’ abilities and unmet expectations regarding their surgical experience. The middle clustering highlights moderate abilities across patients. The logical progression of the logits from 1 to 4 for items F, B, E, and D, shown as black lines, represents the increasing levels of agreement or response categories for these items. The location of the mean logit (black solid dot) indicates the average level of challenge or ease with which patients agreed with each survey question. Item (F) “How likely are you to recommend this procedure to others with similar conditions?”: The placement of its mean logit suggests that most patients found it easy to agree, aligning with the “very high” agreement level. Item (B) “How satisfied were you with the need for additional care?” and item (E) “How would you rate the endoscopic procedure’s impact on your overall well-being?”: Their mean logits indicate moderate ease of agreement, reflecting the mixed levels of satisfaction and perceived impact. Item (D) “How much pain or discomfort did you experience during the recovery process?”: The mean logit’s position shows variable responses, suggesting that pain during recovery was more challenging to evaluate consistently among patients. Item thresholds indicate varied expectations, with “To what extent did the surgical outcome meet your expectations?” (A) showing moderate unmet expectations. Items such as “How satisfied were you with the need for additional care?” (C) indicating high satisfaction and recommendation likelihood. Communication effectiveness is noted through (G) “How thoroughly did your surgeon explain the expected outcomes?”, where variability suggests areas for improvement.

The Rasch analysis of the remaining survey questions regarding patients’ perceptions about their experience when going through the process of a TELD procedure and their experiences in the postoperative recovery process provided additional insights that are relevant in defining clinical outcomes with the procedure. Analysis of the model’s fit and effectiveness indicated less consistency among patient responses for the second set of survey questions, with a person reliability of 0.603. With an MADaQ3 of 0.228 and a significant P value (<0.001), the data suggest a reasonable fit to the Rasch model. Comparing models, the PCM exhibits a log-likelihood of −705 and deviance of 1410, with an Akaike information criterion of 1500 and a Bayesian information criterion of 1599 across 45 parameters for 67 patients. The rating scale model, slightly simpler with 15 parameters, presents a log-likelihood of −734, indicating a slightly poorer fit than PCM.

The Q3 Correlation Matrix reveals positive correlations among items “How did it turn out—as it was explained?” (H), “How often do you still need pain medications?” (I), and “anti-inflammatories” (J), indicating aligned patient responses, while negative correlations, especially with “chiropractor” (M), suggest differing perceptions or experiences as to the usefulness of continued chiropractic care after transforaminal endoscopic decompression surgery. Examining item statistics, items “physical therapy” (L) and “pain management doctor” (Q) show lower outfit values, suggesting predictable responses, whereas “How often do you still need pain medications?” (I) and “anti-inflammatories” (J) present higher outfit values, indicating some unexpected responses. Most items have infit values near 1, reflecting decent predictability. In the delta-tau parameterization, the measure of each item varies. “How did it turn out—as it was explained?” (H) displays varied parameters, whereas “How often do you still need pain medications?” (I) and “anti-inflammatories” (J) indicate closer clustering, suggesting more consistent experiences. Overall, the analysis reflects a moderate fit for the model, with some items such as “chiropractor” (M) showing variation, highlighting areas for further evaluation to ensure they align with patient experiences. The respective fit statistics are listed in Table 2, which prioritizes the survey items from strongest to weakest patient agreement.

The corresponding person-item map (Figure 5) provides additional insights into patients’ perceptions and the level of agreement (item difficulties) on questions regarding their postoperative recovery, postoperative pain management, other treatments, interventions, and consultations. The gray bars show the distribution of patient abilities, with most clustered in the middle, indicating moderate levels of agreement or perception of outcomes. The red lines and dots display expectation levels across survey questions. Close-spaced thresholds imply consistent patient responses, reflecting similar perceptions, while wider spacing suggests more variability. “How did it turn out—as it was explained?” (H) is positioned where patients generally agree, indicating expectations were mostly met. However, “How often do you still need pain medications?” (I) and “anti-inflammatories” (J) show variability, reflecting diverse experiences in medication needs. Treatments such as “physical therapy” (L) and “chiropractor” (M) indicate high agreement, suggesting they were well received. Similarly, “acupuncture” (O) and “pain management doctor” (Q) align with high patient satisfaction. In contrast, “prescription pain killers” (K), “massage” (N), “yoga” (P), and “other spine surgeon” (R) reflect moderate to variable responses, highlighting areas of low perceived additional benefits with mixed patient experiences. The lack of logical progression of the logits suggests that certain items do not align well across response categories, indicating inconsistencies in how patients perceive or respond to these aspects of care.

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Figure 5

The person-item map illustrates patient abilities and expectations regarding survey questions related to postoperative care and treatments. The gray bars represent the distribution of patient abilities, predominantly centered, indicating moderate agreement levels. Red lines and dots depict expectation thresholds across items, revealing consistent responses where thresholds are closely spaced and variability where they are wider. Items such as “physical therapy” (L) and “chiropractor” (M) show high agreement, while “How often do you still need pain medications?” (I) and “anti-inflammatories” (J) indicate more variability, reflecting diverse patient experiences. The map identifies areas of consistent satisfaction and opportunities for improvement, indicated by the lack of logical progression in some logits.