Evidence map›Paper›PMID 39765265›Full record

ArticleNeurospine2024

Reducing Postoperative Neurological Complications in Uniportal Full-Endoscopic Lumbar Interbody Fusion: Efficacy of the GUARD Technique Combined With Delayed Ligamentum Flavectomy.

Hao-Chun Chuang, Yu-Chia Hsu, Yuan-Fu Liu, Chao-Jui Chang, Yu-Meng Hsiao, Yi-Hung Huang, Keng-Chang Liu, Chien-Min Chen, Hyeun Sung Kim, Cheng-Li Lin

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Neurospine, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Hao-Chun ChuangDepartment of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Yu-Chia HsuDepartment of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Yuan-Fu LiuDepartment of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Chao-Jui ChangDepartment of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan.
Yu-Meng HsiaoDepartment of Orthopedics, Tainan Municipal An-Nan Hospital, China Medical University, Tainan, Taiwan.
Yi-Hung HuangDepartment of Orthopedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan.
Keng-Chang LiuDepartment of Orthopedic Surgery, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan.
Chien-Min ChenDivision of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan.
Hyeun Sung KimDepartment of Neurosurgery, Harrison Spinartus Hospital Chungdam, Seoul, Korea.
Cheng-Li LinDepartment of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.

Funding

National Cheng Kung University Hospital NCKUH-11302030National Cheng Kung University Hospital NCKUH-11310001Taiwan National Science and Technology Council NSTC 112-2314-B-006-075
6 · The paper itself

Abstract

objectiveUniportal full-endoscopic transforaminal lumbar interbody fusion (FE-TLIF) carries a unique risk of nerve traction and abrasion injury during cage insertion. This study aims to evaluate the clinical efficacy of the GUARD technique and delayed ligamentum flavectomy in reducing postoperative radicular pain and neurapraxia in patients undergoing uniportal FE-TLIF.

methodsA retrospective analysis was conducted on 45 patients with an average age of 53.9±12.4 years who underwent either FE facet-sparing TLIF (FE fs-TLIF) or FE facet-resecting TLIF (FE fr-TLIF). Patients were divided into 2 groups: the sentinel group (21 patients) using traditional sentinel pin techniques, and the GUARD group (24 patients) using the GUARD technique with delayed ligamentum flavectomy. Patient-reported outcomes included the visual analogue scale (VAS) for leg and back pain, and Oswestry Disability Index. Complication rates, including incidental durotomy, postoperative neurapraxia, and hematoma, were also documented.

resultsPostoperative radicular pain in the legs was significantly reduced at 6 weeks in the GUARD group compared to the sentinel group (VAS: 2.201 vs. 3.267, p=0.021). The incidence of postoperative neurapraxia was markedly lower in the GUARD group (0% vs. 19%, p=0.047). Both groups showed similar improvements in disc height, segmental lordosis, and lumbar lordosis at the 1-year follow-up, with no significant differences in endplate injury or fusion rates.

conclusionThe GUARD technique and delayed ligamentum flavectomy significantly enhance patient safety by reducing postoperative radicular pain and neurapraxia without incurring additional costs. These techniques are easy to learn and integrate into existing surgical workflows, offering a valuable improvement for surgeons performing FE-TLIF procedures.

Indexed as

Cage gliderEndoscopeInterbody fusionLigamentum flavumLumbar spineNeurapraxia

Identifiers

PMID39765265
PMCPMC11744540

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.