Reducing Postoperative Neurological Complications in Uniportal Full-Endoscopic Lumbar Interbody Fusion: Efficacy of the GUARD Technique Combined With Delayed Ligamentum Flavectomy
Objective Uniportal full-endoscopic transforaminal lumbar interbody fusion (FE-TLIF) carries a unique risk of nerve traction and abrasion injury during cage insertion. This study aims to evaluate the clinical efficacy of the GUARD technique and delayed ligamentum flavectomy in reducing postoperative...
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Korean Spinal Neurosurgery Society
2024-12-01
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| Series: | Neurospine |
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| Online Access: | http://e-neurospine.org/upload/pdf/ns-2448656-328.pdf |
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| author | Hao-Chun Chuang Yu-Chia Hsu Yuan-Fu Liu Chao-Jui Chang Yu-Meng Hsiao Yi-Hung Huang Keng-Chang Liu Chien-Min Chen Hyeun Sung Kim Cheng-Li Lin |
| author_facet | Hao-Chun Chuang Yu-Chia Hsu Yuan-Fu Liu Chao-Jui Chang Yu-Meng Hsiao Yi-Hung Huang Keng-Chang Liu Chien-Min Chen Hyeun Sung Kim Cheng-Li Lin |
| author_sort | Hao-Chun Chuang |
| collection | DOAJ |
| description | Objective Uniportal full-endoscopic transforaminal lumbar interbody fusion (FE-TLIF) carries a unique risk of nerve traction and abrasion injury during cage insertion. This study aims to evaluate the clinical efficacy of the GUARD technique and delayed ligamentum flavectomy in reducing postoperative radicular pain and neurapraxia in patients undergoing uniportal FE-TLIF. Methods A retrospective analysis was conducted on 45 patients with an average age of 53.9±12.4 years who underwent either FE facet-sparing TLIF (FE fs-TLIF) or FE facet-resecting TLIF (FE fr-TLIF). Patients were divided into 2 groups: the sentinel group (21 patients) using traditional sentinel pin techniques, and the GUARD group (24 patients) using the GUARD technique with delayed ligamentum flavectomy. Patient-reported outcomes included the visual analogue scale (VAS) for leg and back pain, and Oswestry Disability Index. Complication rates, including incidental durotomy, postoperative neurapraxia, and hematoma, were also documented. Results Postoperative radicular pain in the legs was significantly reduced at 6 weeks in the GUARD group compared to the sentinel group (VAS: 2.201 vs. 3.267, p=0.021). The incidence of postoperative neurapraxia was markedly lower in the GUARD group (0% vs. 19%, p=0.047). Both groups showed similar improvements in disc height, segmental lordosis, and lumbar lordosis at the 1-year follow-up, with no significant differences in endplate injury or fusion rates. Conclusion The GUARD technique and delayed ligamentum flavectomy significantly enhance patient safety by reducing postoperative radicular pain and neurapraxia without incurring additional costs. These techniques are easy to learn and integrate into existing surgical workflows, offering a valuable improvement for surgeons performing FE-TLIF procedures. |
| format | Article |
| id | doaj-art-5fc70de1b45a445a864a25287fb91b2e |
| institution | DOAJ |
| issn | 2586-6583 2586-6591 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Korean Spinal Neurosurgery Society |
| record_format | Article |
| series | Neurospine |
| spelling | doaj-art-5fc70de1b45a445a864a25287fb91b2e2025-08-20T03:06:14ZengKorean Spinal Neurosurgery SocietyNeurospine2586-65832586-65912024-12-012141199120910.14245/ns.2448656.3281635Reducing Postoperative Neurological Complications in Uniportal Full-Endoscopic Lumbar Interbody Fusion: Efficacy of the GUARD Technique Combined With Delayed Ligamentum FlavectomyHao-Chun Chuang0Yu-Chia Hsu1Yuan-Fu Liu2Chao-Jui Chang3Yu-Meng Hsiao4Yi-Hung Huang5Keng-Chang Liu6Chien-Min Chen7Hyeun Sung Kim8Cheng-Li Lin9 Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan Department of Orthopedics, Tainan Municipal An-Nan Hospital, China Medical University, Tainan, Taiwan Department of Orthopedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan Department of Orthopedic Surgery, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan Department of Neurosurgery, Harrison Spinartus Hospital Chungdam, Seoul, Korea Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, TaiwanObjective Uniportal full-endoscopic transforaminal lumbar interbody fusion (FE-TLIF) carries a unique risk of nerve traction and abrasion injury during cage insertion. This study aims to evaluate the clinical efficacy of the GUARD technique and delayed ligamentum flavectomy in reducing postoperative radicular pain and neurapraxia in patients undergoing uniportal FE-TLIF. Methods A retrospective analysis was conducted on 45 patients with an average age of 53.9±12.4 years who underwent either FE facet-sparing TLIF (FE fs-TLIF) or FE facet-resecting TLIF (FE fr-TLIF). Patients were divided into 2 groups: the sentinel group (21 patients) using traditional sentinel pin techniques, and the GUARD group (24 patients) using the GUARD technique with delayed ligamentum flavectomy. Patient-reported outcomes included the visual analogue scale (VAS) for leg and back pain, and Oswestry Disability Index. Complication rates, including incidental durotomy, postoperative neurapraxia, and hematoma, were also documented. Results Postoperative radicular pain in the legs was significantly reduced at 6 weeks in the GUARD group compared to the sentinel group (VAS: 2.201 vs. 3.267, p=0.021). The incidence of postoperative neurapraxia was markedly lower in the GUARD group (0% vs. 19%, p=0.047). Both groups showed similar improvements in disc height, segmental lordosis, and lumbar lordosis at the 1-year follow-up, with no significant differences in endplate injury or fusion rates. Conclusion The GUARD technique and delayed ligamentum flavectomy significantly enhance patient safety by reducing postoperative radicular pain and neurapraxia without incurring additional costs. These techniques are easy to learn and integrate into existing surgical workflows, offering a valuable improvement for surgeons performing FE-TLIF procedures.http://e-neurospine.org/upload/pdf/ns-2448656-328.pdflumbar spineendoscopeinterbody fusionneurapraxiacage gliderligamentum flavum |
| spellingShingle | Hao-Chun Chuang Yu-Chia Hsu Yuan-Fu Liu Chao-Jui Chang Yu-Meng Hsiao Yi-Hung Huang Keng-Chang Liu Chien-Min Chen Hyeun Sung Kim Cheng-Li Lin Reducing Postoperative Neurological Complications in Uniportal Full-Endoscopic Lumbar Interbody Fusion: Efficacy of the GUARD Technique Combined With Delayed Ligamentum Flavectomy Neurospine lumbar spine endoscope interbody fusion neurapraxia cage glider ligamentum flavum |
| title | Reducing Postoperative Neurological Complications in Uniportal Full-Endoscopic Lumbar Interbody Fusion: Efficacy of the GUARD Technique Combined With Delayed Ligamentum Flavectomy |
| title_full | Reducing Postoperative Neurological Complications in Uniportal Full-Endoscopic Lumbar Interbody Fusion: Efficacy of the GUARD Technique Combined With Delayed Ligamentum Flavectomy |
| title_fullStr | Reducing Postoperative Neurological Complications in Uniportal Full-Endoscopic Lumbar Interbody Fusion: Efficacy of the GUARD Technique Combined With Delayed Ligamentum Flavectomy |
| title_full_unstemmed | Reducing Postoperative Neurological Complications in Uniportal Full-Endoscopic Lumbar Interbody Fusion: Efficacy of the GUARD Technique Combined With Delayed Ligamentum Flavectomy |
| title_short | Reducing Postoperative Neurological Complications in Uniportal Full-Endoscopic Lumbar Interbody Fusion: Efficacy of the GUARD Technique Combined With Delayed Ligamentum Flavectomy |
| title_sort | reducing postoperative neurological complications in uniportal full endoscopic lumbar interbody fusion efficacy of the guard technique combined with delayed ligamentum flavectomy |
| topic | lumbar spine endoscope interbody fusion neurapraxia cage glider ligamentum flavum |
| url | http://e-neurospine.org/upload/pdf/ns-2448656-328.pdf |
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