How to Prevent Nerve Root Injury in Uniportal Full Endoscopic Lumbar Fusion Surgery? Insights From a Cadaveric
Yu-Chia Hsu1, Yuan-Fu Liu1, Chao-Jui Chang1
1Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Spine
|June 13, 2024
Summary
This study analyzed nerve root proximity during endoscopic lumbar fusion. Protection strategies for nerve roots differ between facet-resecting and facet-sparing techniques, guiding safer surgical instrument design and placement.
Area of Science:
- Spine surgery
- Minimally invasive procedures
- Anatomy
Background:
- Endoscopic spine surgery, including full endoscopic facet-resecting (FE fr-TLIF) and full endoscopic facet-sparing (FE fs-TLIF) transforaminal lumbar interbody fusion, is increasingly utilized.
- Nerve root injury remains a significant risk in these minimally invasive procedures.
Purpose of the Study:
- To determine the spatial relationship between surgical instruments and nerve roots during FE fr-TLIF and FE fs-TLIF.
- To propose safe instrumentation insertion techniques and cage glider designs for nerve root protection.
Main Methods:
- Two fresh-frozen cadavers underwent 16 uniportal FE fr-TLIF and FE fs-TLIF procedures performed by eight experienced endoscopic spine surgeons.
- Post-procedure, soft tissues were removed to measure distances between the cage entry point and traversing/exiting nerve roots.
Main Results:
- FE fr-TLIF showed a significantly shorter distance between the cage entry point and the traversing nerve root compared to FE fs-TLIF (3.30 vs. 8.58 mm).
- FE fs-TLIF demonstrated a significantly shorter distance between the cage entry point and the exiting nerve root compared to FE fr-TLIF (3.73 vs. 6.90 mm).
- Specific cage glider designs and insertion techniques were recommended for each approach to protect vulnerable nerve roots.
Conclusions:
- The study clarifies the anatomical relationships crucial for safe uniportal endoscopic lumbar fusion.
- Nerve root protection strategies must be tailored: prioritize the traversing root in FE fr-TLIF and the exiting root in FE fs-TLIF.
- Variations in surgical techniques are essential for optimizing safety in different endoscopic lumbar fusion approaches.
