Neurospine.
2024 Dec;21(4):1199-1209. 10.14245/ns.2448656.328.
Reducing Postoperative Neurological Complications in Uniportal Full-Endoscopic Lumbar Interbody Fusion: Efficacy of the GUARD Technique Combined With Delayed Ligamentum Flavectomy
- Affiliations
-
- 1Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- 2Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
- 3Department of Orthopaedics, Dou-Liou Branch of National Cheng Kung University Hospital, Yunlin, Taiwan
- 4Department of Orthopedics, Tainan Municipal An-Nan Hospital, China Medical University, Tainan, Taiwan
- 5Department of Orthopedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
- 6Department of Orthopedic Surgery, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
- 7Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
- 8Department of Biomedical Sciences, National Chung Cheng University, Chiayi, Taiwan
- 9Department of Neurosurgery, Harrison Spinartus Hospital Chungdam, Seoul, Korea
- KMID: 2563119
- DOI: http://doi.org/10.14245/ns.2448656.328
Abstract
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.
- Full Text Links
-
- Actions
-
Cited
- CITED
-
- Close
- Share
-
- Similar articles
-
- Minimally Invasive Strategy for Uniportal Full-Endoscopic Transforaminal Lumbar Interbody Fusion Using a Large Cage Utilized in Oblique Lumbar Interbody Fusion
- Uniportal Endoscopic Lumbar Interbody Fusion
- Innovative Nerve Root Protection in Full-Endoscopic Facet-Resecting Lumbar Interbody Fusion: Controlled Cage Glider Rotation Using the GUARD (Glider Used As a Rotary Device) Technique
- Comparative Analysis of Uniportal and Biportal Endoscopic Transforaminal Lumbar Interbody Fusion in Early Learning Stage: Technical Considerations and Radiological Outcomes
- Full-endoscopic Trans-Kambin’s Triangle Lumbar Interbody Fusion: Technique and Review of Literature
