{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T19:32:50Z","timestamp":1792179170992,"version":"4.4.0"},"reference-count":59,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2020,8,5]],"date-time":"2020-08-05T00:00:00Z","timestamp":1596585600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>(1) Background: Postoperative nerve root injury with dysesthesia is the most frequent sequela following lumbar endoscopic transforaminal discectomy. At times, it may be accompanied by transient and rarely by permanent motor weakness. The authors hypothesized that direct compression of the exiting nerve root and its dorsal root ganglion (DRG) by manipulating the working cannula or endoscopic instruments may play a role. (2) Objective: To assess whether intraoperative neurophysiological monitoring can help prevent nerve root injury by identifying neurophysiological events during the initial placement of the endoscopic working cannula and the directly visualized video endoscopic procedure. (3) Methods: The authors performed a retrospective chart review of 65 (35 female and 30 male) patients who underwent transforaminal endoscopic decompression for failed non-operative treatment of lumbar disc herniation from 2012 to 2020. The patients\u2019 age ranged from 22 to 86 years, with an average of 51.75 years. Patients in the experimental group (32 patients) had intraoperative neurophysiological monitoring recordings using sensory evoked (SSEP), and transcranial motor evoked potentials (TCEP), those in the control group (32 patients) did not. The SSEP and TCMEP data were analyzed and correlated to the postoperative course, including dysesthesia and clinical outcomes using modified Macnab criteria, Oswestry disability index (ODI), visual analog scale (VAS) for leg and back pain. (4) Results: The surgical levels were L4\/L5 in 44.6%, L5\/S1 in 23.1%, and L3\/L4 in 9.2%. Of the 65 patients, 56.9% (37\/65) had surgery on the left, 36.9% (24\/65) on the right, and the remaining 6.2% (4\/65) underwent bilateral decompression. Postoperative dysesthesia occurred in 2 patients in the experimental and six patients in the control group. In the experimental neuromonitoring group, there was electrodiagnostic evidence of compression of the exiting nerve root\u2019s DRG in 24 (72.7%) of the 32 patients after initial transforaminal placement of the working cannula. A 5% or more decrease and a 50% or more decrease in amplitude of SSEPs and TCEPs recordings of the exiting nerve root were resolved by repositioning the working cannula or by pausing the root manipulation until recovery to baseline, which typically occurred within an average of 1.15 min. In 15 of the 24 patients with such latency and amplitude changes, a foraminoplasty was performed before advancing the endoscopic working cannula via the transforaminal approach into the neuroforamen to avoid an impeding nerve root injury and postoperative dysesthesia. (5) Conclusion: Neuromonitoring enabled the intraoperative diagnosis of DRG compression during the initial transforaminal placement of the endoscopic working cannula. Future studies with more statistical power will have to investigate whether employing neuromonitoring to avoid intraoperative compression of the exiting nerve root is predictive of lower postoperative dysesthesia rates in patients undergoing videoendoscopic transforaminal discectomy.<\/jats:p>","DOI":"10.3390\/brainsci10080522","type":"journal-article","created":{"date-parts":[[2020,8,5]],"date-time":"2020-08-05T15:13:18Z","timestamp":1596640398000},"page":"522","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Feasibility of Using Intraoperative Neuromonitoring in the Prophylaxis of Dysesthesia in Transforaminal Endoscopic Discectomies of the Lumbar Spine"],"prefix":"10.3390","volume":"10","author":[{"given":"Paulo S\u00e9rgio Teixeira","family":"de Carvalho","sequence":"first","affiliation":[{"name":"The Federal University of the State of Rio de Janeiro UNIRIO, Pain and Spine Minimally Invasive Surgery Service at Gaffr\u00e9e Guinle University Hospital HUGG, Tijuca, Rio de Janeiro 20270-004 RJ, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Max Rog\u00e9rio Freitas","family":"Ramos","sequence":"additional","affiliation":[{"name":"Federal University of the Rio de Janeiro State UNIRIO, Orthopedic Clinics at Gaffr\u00e9e Guinle University Hospital HUGG, Tijuca, Rio de Janeiro 20270-004 RJ, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alcy Caio","family":"da Silva Meireles","sequence":"additional","affiliation":[{"name":"The Meireles Neurology Institute, Bonsucesso - Rio de Janeiro 20230-240 RJ, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2921-6481","authenticated-orcid":false,"given":"Alexandre","family":"Peixoto","sequence":"additional","affiliation":[{"name":"Federal University of the Rio de Janeiro State UNIRIO, 775 \u2013 Maracan\u00e3, Rio de Janeiro 20270-004 RJ, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr.","given":"Paulo","family":"de Carvalho","sequence":"additional","affiliation":[{"name":"KRH Nordstadt Krankenhaus Hospital, 30167 Hanover, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge Felipe","family":"Ram\u00edrez Le\u00f3n","sequence":"additional","affiliation":[{"name":"Fundaci\u00f3n Universitaria Sanitas, Cl\u00ednica Reina Sof\u00eda-Cl\u00ednica Colsanitas, Centro de Columna-Cirug\u00eda M\u00ednima Invasiva, Bogot\u00e1 104-76, D.C., Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Yeung","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Albuquerque, University of New Mexico School of Medicine, New Mexico Associate, Desert Institute for Spine Care, Phoenix, AZ 85020, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7842-2914","authenticated-orcid":false,"given":"Kai-Uwe","family":"Lewandrowski","sequence":"additional","affiliation":[{"name":"The Federal University of the State of Rio de Janeiro UNIRIO, Pain and Spine Minimally Invasive Surgery Service at Gaffr\u00e9e Guinle University Hospital HUGG, Tijuca, Rio de Janeiro 20270-004 RJ, Brazil"},{"name":"Fundaci\u00f3n Universitaria Sanitas, Cl\u00ednica Reina Sof\u00eda-Cl\u00ednica Colsanitas, Centro de Columna-Cirug\u00eda M\u00ednima Invasiva, Bogot\u00e1 104-76, D.C., Colombia"},{"name":"Center for Advanced Spine Care of Southern Arizona and Surgical Institute of Tucson, AZ 85712, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,8,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"53","DOI":"10.14444\/6008","article-title":"Incidence, Management, and Cost of Complications After Transforaminal Endoscopic Decompression Surgery for Lumbar Foraminal and Lateral Recess Stenosis: A Value Proposition for Outpatient Ambulatory Surgery","volume":"13","author":"Lewandrowski","year":"2019","journal-title":"Int. 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