Neurospine.
2024 Dec;21(4):1141-1148. 10.14245/ns.2449126.563.
Innovative Nerve Root Protection in Full-Endoscopic Facet-Resecting Lumbar Interbody Fusion: Controlled Cage Glider Rotation Using the GUARD (Glider Used As a Rotary Device) Technique
- Hsu YC
1 - Chuang HC1
- Chang WL2,3
- Liu YF1,3
- Chang CJ2,3
- Hsiao YM4
- Huang YH5
- Liu KC6
- Chen CM7,8
- Kim HS9
- Lin CL1,10,11
- Affiliations
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- 1Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- 2Department of Orthopedic Surgery, Dou-Liou Branch of National Cheng Kung University Hospital, Yunlin, Taiwan
- 3Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan
- 4Department of Orthopedics, Tainan Municipal An-Nan Hospital, China Medical University, Tainan, Taiwan
- 5Department of Orthopedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
- 6Department of Orthopedic Surgery, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
- 7Division of Neurosurgery, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan
- 8Department of Biomedical Sciences, National Chung Cheng University, Chiayi, Taiwan
- 9Department of Neurosurgery, Harrison Spinartus Hospital Chungdam, Seoul, Korea
- 10Musculoskeletal Research Center, Innovation Headquarter, National Cheng Kung University, Tainan, Taiwan
- 11Medical Device Innovation Center, National Cheng Kung University, Tainan, Taiwan
- KMID: 2563111
- DOI: http://doi.org/10.14245/ns.2449126.563
Abstract
- This video presents a case of L4–5 unstable spondylolisthesis treated with full-endoscopic transforaminal lumbar interbody fusion (Endo-TLIF), emphasizing the GUARD (Glider Used as a Rotary Device) technique for nerve root protection. This innovative approach involves controlled rotation of the cage glider before cage insertion to minimize the risk of nerve root injury, a significant complication in Endo-TLIF procedures. The GUARD technique, validated in previous cadaveric studies, provides enhanced safety during cage insertion by protecting the nerve root. A 48-year-old woman with a 3-year history of progressive low back pain and bilateral lower extremity radiculopathy (right-sided predominance) was diagnosed with L4–5 unstable spondylolisthesis and spinal stenosis. After failure of conservative management, she underwent uniportal full-endoscopic facet-resecting transforaminal lumbar interbody fusion using the GUARD technique. Postoperatively, the patient experienced significant symptomatic improvement and resolution of radiculopathy, without any intraoperative nerve root injury or postoperative neurological deficits. This case demonstrates the effectiveness of the GUARD technique in reducing neurological complications and improving patient outcomes.
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