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Demographic, operative, and IONM variables were correlated with new postoperative weakness. Results: Weakness occurred in 4 patients (12.1%), all with grade 3 preoperative stenosis. Neuromonitoring changes correlated with weakness (p \u003C 0.001); all showed sustained MEP decrease at closure. Conclusions: Severe stenosis and preoperative weakness increase risk; IONM changes may provide early warning and guide low irrigation pressures.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/intraoperative-neurophysiological-monitoring-in-full-endoscopic-cervical-endoscopic-ulbd/461597/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/intraoperative-neurophysiological-monitoring-in-full-endoscopic-cervical-endoscopic-ulbd/461597.png","ImageObject",300,407,{"name":42,"@type":43},"PakDamar76","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-07","2026-09-30",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",6,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What was the study’s main objective regarding CE-ULBD and IONM?","Question",{"text":63,"@type":64},"The study aimed to identify risk factors for postoperative neurological deficits after CE-ULBD and to test whether intraoperative neurophysiological monitoring (IONM) can predict impending neurological compromise.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"How was the study conducted and what cases were included?",{"text":68,"@type":64},"A multicenter retrospective review analyzed 42 CE-ULBD procedures performed between 2016 and 2024; 33 cases met inclusion criteria with available imaging and electromyography data.",{"name":70,"@type":61,"acceptedAnswer":71},"Which IONM findings were linked to postoperative weakness?",{"text":72,"@type":64},"Neuromonitoring changes significantly correlated with postoperative weakness, and all patients who developed new postoperative weakness showed sustained motor evoked potential (MEP) decrease at the time of closure.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},461597,1790790004,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,105,109,114,119,122,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":55,"doc_module":4,"doc_module_name":25,"category_name":102,"show_sort_weight":103,"slug":104},"Technology",50,"technology",{"id":106,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":107,"slug":108},7,40,"healthcare",{"id":110,"doc_module":4,"doc_module_name":25,"category_name":111,"show_sort_weight":112,"slug":113},8,"Research & Report",30,"research-report",{"id":115,"doc_module":4,"doc_module_name":25,"category_name":116,"show_sort_weight":117,"slug":118},9,"Religion & Spirituality",20,"religion-spirituality",{"id":117,"doc_module":4,"doc_module_name":25,"category_name":120,"show_sort_weight":117,"slug":121},"World Cup","world-cup",{"id":123,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":123,"slug":125},10,"Lifestyle","lifestyle",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":97,"slug":129},19,"General","general",{"code":4,"msg":82,"data":131},{"doc_id":79,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":4,"category_id":106,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":123,"language":139,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":12,"update_tm":143,"read_time":144},962090893057,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","Article  \nIntraoperative Neurophysiological Monitoring in Full-Endoscopic Cervical Endoscopic ULBD  \nMiles Hudson 1,*, Sarah Esposito 1, Mark M. Zaki 2, Simon M. Glynn 2, Osama N. Kashlan 2, John Ogunlade 3, Chandan Krishna 1, Joshua Bakhsheshian 1 and Christoph P. Hofstetter 4  \nAcademic Editor: Jae Hwan Cho  \nReceived: 5 November 2025  \nRevised: 15 December 2025  \nAccepted: 24 December 2025  \nPublished: 1 January 2026  \nCopyright: © 2026 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license.  \n1 Mayo Clinic Department of Neurosurgery, 5777 E Mayo Blvd, Phoenix, AZ 85085, USA  \n2 Department of Neurosurgery, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI 48109, USA  \n3 Taylor Family Department of Neurosurgery, Washington University, St. Louis, MO 63110, USA  \n4 Department of Neurosurgery, University of Washington, 908 Jefferson St, Seattle, WA 98104, USA; [chh9045@uw.edu](chh9045@uw.edu)  \n* [Correspondence: hudson.miles@mayo.edu](Correspondence: hudson.miles@mayo.edu)  \nAbstract  \nBackground/Objectives: To evaluate risk factors for postoperative neurological deficits following cervical endoscopic unilateral laminotomy for bilateral decompression (CEULBD) and to determine whether intraoperative neurophysiological monitoring (IONM) can predict neurological compromise. Methods: A multicenter retrospective review was performed on 42 CE-ULBD procedures conducted between 2016 and 2024; 33 cases met the inclusion criteria with available imaging and electromyography data. Demographic, operative, and neurophysiological variables were analyzed. Preoperative stenosis severity was graded using the Kang MRI system. Intraoperative IONM data, including electromyography firing and motor evoked potential (MEP) changes, were correlated with new postoperative weakness. Results: The cohort (69.1% male, mean age 70.2 ± 1.7 years, mean BMI 29.6 ± 1.1) included 56 decompressed levels. The most common operative levels were C3-4 (37%) and C4-5 (24%) . Postoperative weakness occurred in four patients (12.1%), all of whom had severe (Grade 3) preoperative stenosis. Among these, 50% exhibited preoperative weakness. Neuromonitoring changes correlated significantly with postoperative weakness (Fisher’s Exact, p \u003C 0.001); 100% of patients with new post-operative weakness had sustained MEP decrease at the time of closure. Conclusions: Patients with severe cervical stenosis and preoperative weakness are at heightened risk of postoperative neurological deficits following CE-ULBD. Elevated epidural pressure from continuous irrigation in a constricted canal may exacerbate cord compression, particularly in those with preexisting myelopathy. IONM changes strongly correlate with new deficits and may exacerbate cord compression, particularly in those with preexisting myelopathy, and may serve as an early warning system for impending neurological injury. Surgeons should exercise caution and maintain low irrigation pressures in patients with severe stenosis undergoing endoscopic cervical decompression.  \nKeywords: endoscopic; spine; transforaminal; cervical; cervical myelopathy; spinal stenosis; motor evoked potentials; surgical complications  \n1. Introduction  \nOver the past few decades, technological innovations, expanded training opportunities, and growing patient demand have driven the broader adoption of both instrumented and non-instrumented minimally invasive spine surgery. Full-endoscopic spine surgery  \nis one of the latest advancements in minimally invasive tubular spine surgery [1] . Utilizing an endoscope with an integrated working channel, illumination, and irrigation, full-endoscopic spine surgery—originally developed for the transforaminal approach [2]—has been adapted to address a wide variety of spinal pathologies [3] . Technical advancements, including irrigation pumps, high-speed burs, radiofrequency pr","cbCaieAAwsBLrW5b","https://ap.wps.com/l/cbCaieAAwsBLrW5b","pdf",361197,"English","# Abstract\n# Introduction\n# Materials and Methods\n## Study Design","[{\"question\":\"What was the study’s main objective regarding CE-ULBD and IONM?\",\"answer\":\"The study aimed to identify risk factors for postoperative neurological deficits after CE-ULBD and to test whether intraoperative neurophysiological monitoring (IONM) can predict impending neurological compromise.\"},{\"question\":\"How was the study conducted and what cases were included?\",\"answer\":\"A multicenter retrospective review analyzed 42 CE-ULBD procedures performed between 2016 and 2024; 33 cases met inclusion criteria with available imaging and electromyography data.\"},{\"question\":\"Which IONM findings were linked to postoperative weakness?\",\"answer\":\"Neuromonitoring changes significantly correlated with postoperative weakness, and all patients who developed new postoperative weakness showed sustained motor evoked potential (MEP) decrease at the time of closure.\"}]","Intraoperative Neurophysiological Monitoring in Full-Endoscopic Cervical Endoscopic ULBD | PDF",1790761940,25]