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Updated: Mar 26, 2026
Cone Beam Intraoperative Computed Tomography-based Image Guidance for Minimally Invasive Transforaminal Interbody Fusion
Published on: August 6, 2019
Postoperative dysesthesia in minimally invasive transforaminal lumbar interbody fusion: a report of five cases
Honggang Wang1, Yue Zhou2, Zhengfeng Zhang3
1Department of Orthopedics, Xinqiao Hospital, Third Military Medical University, 183 Xinqiao Street, Shapingba District, Chongqing, 400037, China.
Objective:
Minimally invasive transforaminal lumbar interbody fusion (misTLIF) can potentially lead to dorsal root ganglion (DRG) injury which may cause postoperative dysesthesia (POD). The purpose of retrospective study was to describe the uncommon complication of POD in misTLIF.
Methods:
Between January 2010 and December 2014, 539 patients were treated with misTLIF in investigator group. POD was defined as dysesthetic pain or burning dysesthesia at a proper DRG innervated region, whether spontaneous or evoked. Non-steroidal antiinflammatory drugs, central non-opioid analgesic agent, neuropathic pain drugs and/or intervertebral foramen block were selectively used to treat POD.
Results:
There were five cases of POD (5/539, 0.9 %), which consisted of one patient in recurrent lumbar disc herniation (1/36, 3 %), one patient in far lateral lumbar disc herniation (1/34, 3 %), and 3 patients in lumbar spondylolisthesis (3/201, 1 %). Two DRG injury cases were confirmed by revision surgery. After the treatment by drugs administration plus DRG block, all patients presented pain relief with duration from 22 to 50 days. A gradual pain moving to distal end of a proper DRG innervated region was found as the beginning of end.
Conclusions:
Although POD is a unique and rare complication and maybe misdiagnosed as nerve root injury in misTLIF, combination drug therapy and DRG block have an effective result of pain relief. The appearance of a gradual pain moving to distal end of a proper DRG innervated region during recovery may be used as a sign for the good prognosis.
Insights
Postoperative dysesthesia (POD) is a rare complication of minimally invasive transforaminal lumbar interbody fusion (misTLIF). Combination drug therapy and dorsal root ganglion (DRG) block effectively relieve POD pain, with pain migration indicating good prognosis.
Area of Science:
- Neurosurgery
- Spinal Fusion Surgery
- Pain Management
Background:
- Minimally invasive transforaminal lumbar interbody fusion (misTLIF) is a surgical technique used for spinal fusion.
- Dorsal root ganglion (DRG) injury is a potential complication of misTLIF, leading to postoperative dysesthesia (POD).
- POD is characterized by dysesthetic pain or burning sensations in a region innervated by the affected DRG.
Purpose of the Study:
- To describe the uncommon complication of postoperative dysesthesia (POD) following misTLIF.
- To report the incidence and characteristics of POD in patients undergoing misTLIF.
- To evaluate the effectiveness of treatment strategies for POD after misTLIF.
Main Methods:
- A retrospective study of 539 patients who underwent misTLIF between January 2010 and December 2014.
- POD was defined as dysesthetic pain or burning in a DRG-innervated region.
- Treatment involved non-steroidal anti-inflammatory drugs, central non-opioid analgesics, neuropathic pain medications, and/or intervertebral foramen blocks.
Main Results:
- Five cases of POD were identified (0.9% incidence).
- POD occurred in 3% of patients with recurrent or far lateral lumbar disc herniation and 1% with lumbar spondylolisthesis.
- Two cases of DRG injury were confirmed during revision surgery. Treatment with medication and DRG block resulted in pain relief lasting 22-50 days.
Conclusions:
- POD is a rare complication of misTLIF, potentially misdiagnosed as nerve root injury.
- Combination drug therapy and DRG block are effective for pain relief in POD.
- Pain migration to a distal area within the DRG-innervated region during recovery may indicate a favorable prognosis.
