Abstract:
Background:
Dorsal root ganglion (DRG) irritation is a frequent complication of transforaminal endoscopic spine surgery, causing acute postoperative dysesthetic radicular pain in up to 20% of patients. While technical and pathological risk factors have been described, the predictive role of foraminal dimensions remain unclear. This study aimed to evaluate whether foraminal area correlates with the incidence of postoperative DRG-related pain.
Methods:
We retrospectively reviewed 500 patients who underwent percutaneous endoscopic discectomy. Preoperative MRI scans were analysed to measure foraminal area at three levels: lower endplate of the superior vertebra, disc level, and upper endplate of the inferior vertebra. Postoperative dysesthetic pain was assessed within 48 hours using a visual analogue scale (VAS). Correlations between foraminal dimensions and pain outcomes were calculated.
Results:
Mean foraminal area ranged from 45–115 mm². Patients with foraminal area <65 mm² experienced a significantly higher incidence of acute dysesthetic pain (p < 0.001). An inverse correlation was observed between foraminal area and VAS pain scores, indicating that smaller foramina were stronglypredictive of increased DRG irritation. These results suggest foraminal area is an independent anatomical risk factor, irrespective of surgical technique.
Conclusion:
Smaller foraminal dimensions are significantly associated with postoperative dysesthetic radicular pain following transforaminal endoscopic procedures. Preoperative assessment of foraminal area may improve risk stratification, guide surgical planning, and enhance patient counseling. To our knowledge, this is the first study to quantitatively demonstrate the predictive impact of foraminal size in Endoscopic Procedures