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Related Experiment Video

Updated: May 16, 2026

Transforaminal Full-Endoscopic Lumbar Foraminotomy Under Local Anesthesia for L5/S1 Adjacent Segment Foraminal Stenosis
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Intraoperative Neuromonitoring Events in Transforaminal Endoscopy Using the Trans-Superior Articular Process

Andrew O Schindler1, Paras Gupta1, Taimur Hassan2

  • 1School of Engineering Medicine, Texas A&M University, Houston , Texas , USA.

Operative Neurosurgery (Hagerstown, Md.)
|May 14, 2026
PubMed
Summary

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This summary is machine-generated.

The trans-superior articular process (trans-SAP) approach for endoscopic diskectomy is safe, with 99.44% of monitored cases showing no adverse events. This finding suggests intraoperative neuromonitoring may not be necessary for this minimally invasive spine surgery technique.

Area of Science:

  • Neurosurgery
  • Minimally Invasive Spine Surgery
  • Spinal Diagnostics

Background:

  • Transforaminal endoscopic diskectomy is effective for thoracic and lumbar disk pathologies.
  • Intraoperative neuromonitoring is traditionally used due to risks to the exiting nerve root.
  • The trans-superior articular process (trans-SAP) approach offers access to lateral recess pathology with theoretically reduced risk to the nerve root.

Purpose of the Study:

  • To investigate the safety of the trans-SAP approach for endoscopic diskectomy.
  • To analyze intraoperative neuromonitoring events in transforaminal endoscopic cases utilizing the trans-SAP technique.

Main Methods:

  • Retrospective analysis of 180 transforaminal endoscopic cases using the trans-SAP approach.
  • Inclusion of cases from four institutions between 2021 and 2024.
Keywords:
Endoscopic spine techniquesIntraoperative neuromonitoringKambin's prismNerve root injuryTrans-SAP approachTransforaminal endoscopic diskectomy

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  • Review of free-running electromyography (EMG) neuromonitoring data for adverse events or EMG triggers.

    • Main Results:

    • Free-running EMG neuromonitoring was utilized in 84.91% of reviewed cases.
    • No adverse monitoring events or EMG triggers were recorded in 99.44% of monitored trans-SAP approach cases.
    • A single case experienced transient neurotonic EMG activity during dissection, resolving without symptoms.

    Conclusions:

    • The trans-SAP approach provides safe access in transforaminal endoscopic diskectomy.
    • The low incidence of neuromonitoring events suggests potential to obviate the need for intraoperative neuromonitoring.
    • This approach may enhance safety and efficiency in treating thoracic and lumbar disk pathologies.