Application of the guidewire anchoring technique in lateral approach transforaminal endoscopic lumbar foraminoplasty: a propensity score-matched retrospective study.

OBJECTIVE

Safe and rapid bony localization for intervertebral foraminoplasty is essential in lateral transforaminal endoscopic lumbar discectomy (TELD). This study introduces a novel guidewire anchoring puncture technique and compares it with conventional puncture to evaluate operative efficiency, safety, and clinical outcomes.

METHODS

A retrospective 1:1 propensity score-matched (PSM) analysis was performed on 60 patients with single-level L4/5 or L5/S1 disc herniation receiving TELD (anchoring group = 30, conventional group = 30). Baseline demographics, intraoperative metrics, neurological complications, and serial Oswestry Disability Index (ODI)/leg pain Numeric Rating Scale (NRS) scores (preoperatively, 1-day, 3-month, 12-month postoperatively) were compared. Post-hoc power calculation and linear mixed-effects models were applied for statistical validation.

RESULTS

Baseline characteristics were balanced after PSM (all standardized mean differences < 0.1). The anchoring group exhibited significantly shorter total operative time, superior articular process (SAP) foraminoplasty time, and fewer fluoroscopic exposures (all P < 0.001). Transient nerve irritation occurred in 3.3% (1/30) of anchoring patients versus 20.0% (6/30) of conventional patients; only one nerve injury (3.3%) appeared in the conventional group (Fisher's exact test P values provided). Intergroup NRS/ODI differences were non-significant at preoperative, 1-day, and 3-month timepoints (P > 0.05). Although the anchoring group had statistically lower 12-month NRS scores (P = 0.0027), the between-group difference failed to meet the established minimal clinically important difference (MCID) for leg pain.

CONCLUSION

The guidewire anchoring technique improves TELD foraminoplasty efficiency and reduces intraoperative radiation and neurological complication risk. However, given the single-center, small-sample, 12-month limited follow-up design, its broad clinical adoption requires further multicenter prospective validation. Both techniques deliver equivalent clinically meaningful long-term pain relief.