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Innovative Nerve Root Protection in Full-Endoscopic Facet-Resecting Lumbar Interbody Fusion: Controlled Cage Glider

Yu-Chia Hsu1, Hao-Chun Chuang1, Wei-Lun Chang2,3

  • 1Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.

Neurospine
|January 7, 2025
PubMed
Summary

The GUARD technique enhances safety in full-endoscopic transforaminal lumbar interbody fusion (Endo-TLIF) by protecting the nerve root during cage insertion. This innovative method reduces neurological complications and improves patient outcomes for conditions like spondylolisthesis.

Keywords:
EndoscopesMinimally invasive surgical proceduresNerve root protectionSpinal fusionSpinal nerve root injurySurgical technique

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Area of Science:

  • Neurosurgery
  • Minimally Invasive Spine Surgery
  • Orthopedic Surgery

Background:

  • L4-L5 unstable spondylolisthesis and spinal stenosis can cause severe low back pain and radiculopathy.
  • Traditional surgical approaches carry risks of nerve root injury during cage insertion in endoscopic procedures.
  • The Glider Used as a Rotary Device (GUARD) technique was developed to mitigate these risks.

Purpose of the Study:

  • To present a case of L4-L5 unstable spondylolisthesis treated with full-endoscopic transforaminal lumbar interbody fusion (Endo-TLIF).
  • To highlight the application and effectiveness of the GUARD technique for nerve root protection during Endo-TLIF.
  • To demonstrate the safety and efficacy of the GUARD technique in reducing neurological complications.

Main Methods:

  • A 48-year-old female patient with symptomatic L4-L5 unstable spondylolisthesis underwent uniportal full-endoscopic facet-resecting transforaminal lumbar interbody fusion.
  • The GUARD technique was employed, involving controlled rotation of the cage glider prior to cage insertion to protect the nerve root.
  • The procedure aimed to achieve spinal stability and decompress neural elements.

Main Results:

  • The patient experienced significant improvement in low back pain and complete resolution of lower extremity radiculopathy postoperatively.
  • No intraoperative nerve root injury or postoperative neurological deficits were observed.
  • The GUARD technique facilitated safe and effective cage insertion, contributing to successful fusion and symptom relief.

Conclusions:

  • The GUARD technique is an effective and safe method for nerve root protection during Endo-TLIF procedures.
  • This technique can significantly reduce the risk of neurological complications associated with cage insertion in endoscopic spine surgery.
  • The successful application of the GUARD technique in this case demonstrates its potential to improve patient outcomes for unstable spondylolisthesis.