Full-endoscopic spinal fusion surgery has emerged as a crucial approach for managing lumbar degenerative spinal disease. A significant concern in endoscopic spinal fusion relates to the vulnerability of neural structures, particularly the risk of nerve root injury (NRI). This comprehensive review evaluates the critical importance of preserving neurological integrity during endoscopic spinal fusion procedures, focusing on multifactorial contributors to risk and effective strategies for safeguarding the nerve root. The review thoroughly examines anatomical considerations, surgical techniques, the utilization of specialized intraoperative instrumentation, and intraoperative monitoring as key factors influencing the risk of NRI. Understanding these variables is paramount for minimizing postoperative neurological complications and improving patient outcomes. The article succinctly summarizes the clinical presentation of nerve root injuries and recommends therapeutic interventions. It also discusses strategies for preventing NRI, emphasizing both preoperative considerations and intraoperative measures. This comprehensive review provides spine surgeons with valuable insights, highlighting the significance of meticulous techniques and preventive measures to optimize patient safety and overall surgical success in the context of endoscopic spinal fusion.

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