Augmenting Endoscopic Transforaminal Spinal Decompression Surgery (Full Endoscopic Spine Surgery) Using Stimulated...

Area of Science:

• Neurosurgery
• Minimally Invasive Spine Surgery
• Spinal Instrumentation

Background:

• Full endoscopic spine surgery via transforaminal approach (FESS-TFA) is a minimally invasive technique for spinal decompression.
• A significant risk associated with FESS-TFA is nerve root irritation or injury.
• Current intraoperative neuromonitoring methods often provide only retrospective warnings of neural disturbances.

Purpose of the Study:

• To introduce and evaluate the use of stimulated electromyography neuromonitoring dilators in FESS-TFA.
• To achieve proactive nerve protection and improved nerve localization.
• To explore the potential for reduced radiation exposure during the procedure.

Main Methods:

• This technical note details the initial application of neuromonitoring dilators in FESS-TFA.
• A specialized 6-mm dilator equipped with a stimulation electrode was utilized.
• The dilator provided real-time feedback on nerve proximity, guiding surgeons to avoid accidental nerve root injury and create a safe surgical tract.

Main Results:

• The technique was successfully implemented in a patient with T11/T12 severe spinal stenosis.
• Facilitated safe passage of instruments and accurate nerve localization.
• The study describes the surgical technique and presents intraoperative findings.

Conclusions:

• Neuromonitoring dilators show promise as an innovation for enhancing safety in FESS-TFA.
• This technique may help optimize surgical workflows and improve patient outcomes by reducing neural complications.
• Further large-scale studies are needed to quantify the impact on complication rates, operative time, and radiation exposure.