Neurologic deficit following lateral lumbar interbody fusion

Pumberger, Matthias; Hughes, Alexander P.; Huang, Russel; Sama, Andrew A.; Cammisa, Frank P.; Girardi, Federico P.

doi:10.1007/s00586-011-2087-9

Cited by 165 publications

(106 citation statements)

References 23 publications

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“…The most common complication is anterior thigh pain and numbness, which result from irritating the psoas muscle or transient irritation of the genitofemoral nerve [1,4,5,8]. Pumberger et al [17] examined 181 patients at our institute. No visceral organ injuries or iliac vessel injuries was detected.…”

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confidence: 99%

Lateral Lumbar Interbody Fusion

Sharma

Kepler

Girardi

et al. 2011

Journal of Spinal Disorders &Amp; Techniques

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207

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The lateral lumbar interbody fusion (LLIF) is a relatively new technique that allows the surgeon to access the intervertebral space from a direct lateral approach either anterior to or through the psoas muscle. This approach provides an alternative to anterior lumbar interbody fusion with instrumentation, posterior lumbar interbody fusion, and transforaminal lumbar interbody fusion for anterior column support. LLIF is minimally invasive, safe, better structural support from the apophyseal ring, potential for coronal plane deformity correction, and indirect decompression, which have has made this technique popular. LLIF is currently being utilized for a variety of pathologies including but not limited to adult de novo lumbar scoliosis, central and foraminal stenosis, spondylolisthesis, and adjacent segment degeneration. Although early clinical outcomes have been good, the potential for significant neurological and vascular vertebral endplate complications exists. Nevertheless, LLIF is a promising technique with the potential to more effectively treat complex adult de novo scoliosis and achieve predictable fusion while avoiding the complications of traditional anterior surgery and posterior interbody techniques.

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confidence: 99%

Lateral Lumbar Interbody Fusion

Sharma

Kepler

Girardi

et al. 2011

Journal of Spinal Disorders &Amp; Techniques

Self Cite

207

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“…Injuries to the psoas muscle, ventral nerve root, and/or the genitofemoral nerve are potential risks that could occur during surgery. Because of these risks, use of electromyographic monitoring system during surgery has become standard with lateral interbody fuson and the procedure would not be possible without it [2][3][4][5][6][7]. However, cases of palsy have been reported in the literature even though the neuromonitoring did not show any injury.…”

Section: Spine Research Issn 2471-8173mentioning

confidence: 99%

“…However, cases of paresis have been reported in the literature even though the neuromonitoring did not demonstrate any EMG changes [4][5][6]. In one case report by Houten et al, the authors report two cases where patients underwent L3-4 and L4-5 lateral interbody fusions where patients had hip flexion weakness and paresthesias despite normal neuromonitoring [5].…”

Section: Introductionmentioning

confidence: 99%

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The Reliability of Neuromonitoring to Detect Neurologic Injury during Lateral Interbody Fusion

Lee¹,

Gertsch²,

Taylor³

et al. 2015

Spine Res

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Summary of background data: Lateral interbody fusion is a minimally invasive procedure that is gaining popularity. Hip flexion weakness has been noted postoperatively but the cause of the weakness still remains unknown. The objective of this study is to evaluate if conventional neuromonitoring with electromyography (EMG), somatosensory (SSEP), and motor evoked potentials (MEP) allows surgeons to detect potential nerve injuries that standard EMG monitoring may miss. Method:Patients undergoing lateral interbody fusion were monitored with standard electromyography and conventional neuromonitoring with electromyography, somatosensory evoked potentials, and motor evoke potentials. All consecutive lateral interbody fusion patients who had a minimum 2-year follow-up were included in the analysis. Data gathered included VAS, ODI, as well as radiographic fusion assessment. Hip flexion weakness was considered significant if the muscle grade decreased by 2 or more.Results: 113 subjects were recruited for this study. Pain scores (visual analog scores) decreased from 6.4 ± 2.1 pre-operatively to 3.2 ± 2.35 post-operatively at 2 years (p<0.0001). Functional scores (Oswestry Disability Index) improved by 30% from 41.5 ± 14.6 pre-operatively to 29.2 ± 17.5 post-operatively at 2-year follow-up (p<0.0001). 3 cases of significant hip flexion weakness were noted postoperatively. Electromyography from both systems and somatosensory evoked potenatials from conventional neuromonitoring were unchanged during these cases. Changes were noted on motor evoked potenatials in all three of these cases. This suggests that the hip flexion weakness may be due to a neurologic injury that is occurring during the case despite normal electromyography readings.Discussion: Electromyography is a reliable monitoring tool during lateral intrerbody fusion surgery with a reliability of 97.5% (110/113). However, there is the potential of neurologic injury despite normal electromyograpy and somatorsensory evoked potentials during the case. Physicians need to be aware of this and patients should be counseled appropriately.

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“…In 2011, two articles [2,3] provided important knowledge on the regional neural and vascular anatomy related to the transpsoas approach, providing quantitative and qualitative data to better understand and control the risk of injury to the lumbar plexus. In 2012, a retrospective study [4] on the neurological safety of the procedure (one of the hottest topics related to transpsoas surgery) was published in the Journal. Other papers have shown clinical results [5,6] for early applications, such as degenerative disc disease and degenerative spondylolisthesis or stenosis.…”

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confidence: 99%