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This procedure helps guide operative procedures, reduces neurological complications and improves surgical safety. To assess the online functional integrity of nerve roots during PE-TLIF, intra-operative neurophysiological monitoring (IONM) has been extensively used.
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However, due to the insufficient operative field and the limited exposure of anatomical landmarks, the risk of iatrogenic neurological injury is increased during PE-TLIF surgeries. Percutaneous endoscopic transforaminal lumbar interbody fusion (PE-TLIF) surgeries directly realize decompression and fusion without destruction of the posterior spinal components. Minimally invasive surgery (MIS) has been widely accepted as a better alternative for the treatment of lumbar spinal disorders. MIONM is more effective and accurate than unimodal monitoring in assessing nerve root function during PE-TLIF surgeries, reducing both neurological complications and false-negative findings. The ability of single IONM modalities to detect neurological complications varied between 25.0 and 66.6%, whereas that of all modalities was 100%. The frequency of neurological complications, including minor deficits, was 6.2% ( n = 7) all of the neurological complications were temporary. The MIONM sensitivity and specificity were 100 and 96.2%, respectively.
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Of the 113 consecutive patients, 12 (10.6%) with IONM alerts were identified. Postoperative neurological deficits were documented and analyzed, and the efficacy and specificity of various IONM techniques were compared. MIONM data from 113 consecutive patients who underwent PE-TLIF surgeries between June 2018 and April 2020 were retrospectively reviewed. Despite the wide use of intraoperative neurophysiological monitoring (IONM) in spinal surgeries, the efficacy of IONM during percutaneous endoscopic transforaminal lumbar interbody fusion (PE-TLIF) surgery in detecting postoperative neurological deficits has not been well characterized.