Skip to main content
Erschienen in: European Spine Journal 6/2012

01.06.2012 | Original Article

Neurologic deficit following lateral lumbar interbody fusion

verfasst von: Matthias Pumberger, Alexander P. Hughes, Russel R. Huang, Andrew A. Sama, Frank P. Cammisa, Federico P. Girardi

Erschienen in: European Spine Journal | Ausgabe 6/2012

Einloggen, um Zugang zu erhalten

Abstract

Purpose

Lateral lumbar interbody fusion (LLIF) is a minimally invasive technique that has gained growing interest in recent years. We performed a retrospective review of the medical records and operative reports of patients undergoing LLIF between March 2006 and December 2009. We seek to identify the incidence and nature of neurological deficits following LLIF.

Methods

New occurring sensory and motor deficits were recorded at 6 and 12 weeks as well as 6- and 12 months of follow-up. Motor deficits were grouped according to the muscle weakness and severity and sensory deficits to the dermatomal zone. New events were correlated to the patient demographics, pre-operative diagnosis, operative levels, and duration of surgery. At each post-operative time-point patients were queried regarding the presence of leg pain.

Results

A total of 235 patients (139 F; 96 M) with a total of 444 levels fused were included. Average age was 61.5 and mean BMI 28.3. At 12 months’ follow-up, the prevalence of sensory deficits was 1.6%, psoas mechanical deficit was 1.6% and lumbar plexus related deficits 2.9%. Although there was no significant correlation between the surgical level L4–5 and an increased psoas mechanical flexion or lumbar plexus related motor deficit, a trend was observed. Independent risk factors for both psoas mechanical hip flexion deficit and lumbar plexus related motor deficit was duration of surgery.

Conclusion

LLIF is a valuable tool for achieving fusion through a minimally invasive approach with little risk to neurovascular structures.
Literatur
1.
Zurück zum Zitat Oliveira L, Marchi L, Coutinho E, Pimenta L (2010) A radiographic assessment of the ability of the extreme lateral interbody fusion procedure to indirectly decompress the neural elements. Spine (Phila Pa 1976) 35(26 Suppl):S331–S337CrossRef Oliveira L, Marchi L, Coutinho E, Pimenta L (2010) A radiographic assessment of the ability of the extreme lateral interbody fusion procedure to indirectly decompress the neural elements. Spine (Phila Pa 1976) 35(26 Suppl):S331–S337CrossRef
2.
Zurück zum Zitat Sharma AK, Kepler CK, Girardi FP, Cammisa FP, Huang RC, Sama AA (2011) Lateral lumbar interbody fusion: clinical and radiographic outcomes at 1 year: a preliminary report. J Spinal Disord Tech 24:242–250PubMedCrossRef Sharma AK, Kepler CK, Girardi FP, Cammisa FP, Huang RC, Sama AA (2011) Lateral lumbar interbody fusion: clinical and radiographic outcomes at 1 year: a preliminary report. J Spinal Disord Tech 24:242–250PubMedCrossRef
3.
Zurück zum Zitat Ozgur BM, Aryan HE, Pimenta L et al (2006) Extreme lateral interbody fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion. Spine J 6:435–443PubMedCrossRef Ozgur BM, Aryan HE, Pimenta L et al (2006) Extreme lateral interbody fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion. Spine J 6:435–443PubMedCrossRef
4.
Zurück zum Zitat Berjano P, Lamartina C (2011) Minimally invasive lateral transpsoas approach with advanced neurophysiologic monitoring for lumbar interbody fusion. Eur Spine J 20(9):1584–1586PubMedCrossRef Berjano P, Lamartina C (2011) Minimally invasive lateral transpsoas approach with advanced neurophysiologic monitoring for lumbar interbody fusion. Eur Spine J 20(9):1584–1586PubMedCrossRef
5.
Zurück zum Zitat Moro T, Kikuchi S, Konno S et al (2003) An anatomic study of the lumbar plexus with respect to retroperitoneal endoscopic surgery. Spine 28:423–428PubMed Moro T, Kikuchi S, Konno S et al (2003) An anatomic study of the lumbar plexus with respect to retroperitoneal endoscopic surgery. Spine 28:423–428PubMed
6.
Zurück zum Zitat Park DK, Lee MJ, Lin EL et al (2010) The relationship of intrapsoas nerves during a transpsoas approach to the lumbar spine. J Spinal Disord Tech 23:223–228PubMedCrossRef Park DK, Lee MJ, Lin EL et al (2010) The relationship of intrapsoas nerves during a transpsoas approach to the lumbar spine. J Spinal Disord Tech 23:223–228PubMedCrossRef
7.
Zurück zum Zitat Benglis DM, Vanni S, Levi AD et al (2009) An anatomical study of the lumbosacral plexus as related to the minimally invasive transpsoas approach to the lumbar spine. J Neurosurg Spine 10:139–144PubMedCrossRef Benglis DM, Vanni S, Levi AD et al (2009) An anatomical study of the lumbosacral plexus as related to the minimally invasive transpsoas approach to the lumbar spine. J Neurosurg Spine 10:139–144PubMedCrossRef
8.
Zurück zum Zitat Regev GJ, Chen L, Dhawan M et al (2009) Morphometric analysis of the ventral nerve roots and retroperitoneal vessels with respect to the minimally invasive lateral approach in normal and deformed spines. Spine (Phila Pa 1976) 34:1330–1335CrossRef Regev GJ, Chen L, Dhawan M et al (2009) Morphometric analysis of the ventral nerve roots and retroperitoneal vessels with respect to the minimally invasive lateral approach in normal and deformed spines. Spine (Phila Pa 1976) 34:1330–1335CrossRef
9.
Zurück zum Zitat Kepler CK, Bogner EA, Herzog RJ et al (2010) Anatomy of the psoas muscle and lumbar plexus with respect to the surgical approach for lateral transpsoas interbody fusion. Eur Spine J (Epub ahead of print) Kepler CK, Bogner EA, Herzog RJ et al (2010) Anatomy of the psoas muscle and lumbar plexus with respect to the surgical approach for lateral transpsoas interbody fusion. Eur Spine J (Epub ahead of print)
10.
Zurück zum Zitat Tormenti MJ, Maserati MB, Bonfield CM, Okonkwo DO, Kanter AS (2010) Complications and radiographic correction in adult scoliosis following combined transpsoas extreme lateral interbody fusion and posterior pedicle screw instrumentation. Neurosurg Focus 28:E7PubMedCrossRef Tormenti MJ, Maserati MB, Bonfield CM, Okonkwo DO, Kanter AS (2010) Complications and radiographic correction in adult scoliosis following combined transpsoas extreme lateral interbody fusion and posterior pedicle screw instrumentation. Neurosurg Focus 28:E7PubMedCrossRef
11.
Zurück zum Zitat Rodgers WB, Gerber EJ, Patterson J (2011) Intraoperative and early postoperative complications in extreme lateral interbody fusion: an analysis of 600 cases. Spine (Phila Pa 1976) 36:26–32CrossRef Rodgers WB, Gerber EJ, Patterson J (2011) Intraoperative and early postoperative complications in extreme lateral interbody fusion: an analysis of 600 cases. Spine (Phila Pa 1976) 36:26–32CrossRef
12.
Zurück zum Zitat Tohmeh AG, Rodgers WB, Peterson MD (2011) Dynamically evoked, discrete-threshold electromyography in the extreme lateral interbody fusion approach. J Neurosurg Spine 14:31–37PubMedCrossRef Tohmeh AG, Rodgers WB, Peterson MD (2011) Dynamically evoked, discrete-threshold electromyography in the extreme lateral interbody fusion approach. J Neurosurg Spine 14:31–37PubMedCrossRef
13.
Zurück zum Zitat Isaacs RE, Hyde J, Goodrich JA, Rodgers WB, Phillips FM (2010) A prospective, nonrandomized, multicenter evaluation of extreme lateral interbody fusion for the treatment of adult degenerative scoliosis: perioperative outcomes and complications. Spine (Phila Pa 1976) 35(26 Suppl):S322–S330CrossRef Isaacs RE, Hyde J, Goodrich JA, Rodgers WB, Phillips FM (2010) A prospective, nonrandomized, multicenter evaluation of extreme lateral interbody fusion for the treatment of adult degenerative scoliosis: perioperative outcomes and complications. Spine (Phila Pa 1976) 35(26 Suppl):S322–S330CrossRef
14.
Zurück zum Zitat Papanastassiou ID, Eleraky M, Vrionis FD (2011) Contralateral femoral nerve compression: an unrecognized complication after extreme lateral interbody fusion (XLIF). J Clin Neurosci 18:149–151PubMedCrossRef Papanastassiou ID, Eleraky M, Vrionis FD (2011) Contralateral femoral nerve compression: an unrecognized complication after extreme lateral interbody fusion (XLIF). J Clin Neurosci 18:149–151PubMedCrossRef
15.
Zurück zum Zitat Pimenta L, Oliveira L, Schaffa T, Coutinho E, Marchi L (2011) Lumbar total disc replacement from an extreme lateral approach: clinical experience with a minimum of 2 years’ follow-up. J Neurosurg Spine 14:38–45PubMedCrossRef Pimenta L, Oliveira L, Schaffa T, Coutinho E, Marchi L (2011) Lumbar total disc replacement from an extreme lateral approach: clinical experience with a minimum of 2 years’ follow-up. J Neurosurg Spine 14:38–45PubMedCrossRef
16.
Zurück zum Zitat Youssef JA, McAfee PC, Patty CA, Raley E, DeBauche S, Shucosky E, Chotikul L (2010) Minimally invasive surgery: lateral approach interbody fusion: results and review. Spine (Phila Pa 1976) 35(26 Suppl):S302–S311CrossRef Youssef JA, McAfee PC, Patty CA, Raley E, DeBauche S, Shucosky E, Chotikul L (2010) Minimally invasive surgery: lateral approach interbody fusion: results and review. Spine (Phila Pa 1976) 35(26 Suppl):S302–S311CrossRef
17.
Zurück zum Zitat Uribe JS, Arredondo N, Dakwar E et al (2010) Defining the safe working zones using the minimally invasive lateral retroperitoneal transpsoas approach: an anatomical study. J Neurosurg Spine 13:260–266PubMedCrossRef Uribe JS, Arredondo N, Dakwar E et al (2010) Defining the safe working zones using the minimally invasive lateral retroperitoneal transpsoas approach: an anatomical study. J Neurosurg Spine 13:260–266PubMedCrossRef
18.
Zurück zum Zitat Hu WK, He SS, Zhang SC, Liu YB, Li M, Hou TS, Ma XL, Wang J (2011) An MRI study of psoas major and abdominal large vessels with respect to the X/DLIF approach. Eur Spine J 20(4):557–562PubMedCrossRef Hu WK, He SS, Zhang SC, Liu YB, Li M, Hou TS, Ma XL, Wang J (2011) An MRI study of psoas major and abdominal large vessels with respect to the X/DLIF approach. Eur Spine J 20(4):557–562PubMedCrossRef
19.
Zurück zum Zitat Houten JK, Alexandre LC, Nasser R, Wollowick AL (2011) Nerve injury during the transpsoas approach for lumbar fusion. J Neurosurg Spine 27. (Epub ahead of print) Houten JK, Alexandre LC, Nasser R, Wollowick AL (2011) Nerve injury during the transpsoas approach for lumbar fusion. J Neurosurg Spine 27. (Epub ahead of print)
20.
Zurück zum Zitat Mura PP, Costaglioli M, Piredda M, Caboni S, Casula S (2011) TLIF for symptomatic disc degeneration: a retrospective study of 100 patients. Eur Spine J 20(Suppl 1):S57–S60PubMedCrossRef Mura PP, Costaglioli M, Piredda M, Caboni S, Casula S (2011) TLIF for symptomatic disc degeneration: a retrospective study of 100 patients. Eur Spine J 20(Suppl 1):S57–S60PubMedCrossRef
21.
Zurück zum Zitat Barnes B, Rodts GE Jr, Haid RW Jr, Subach BR, McLaughlin MR (2002) Allograft implants for posterior lumbar interbody fusion: results comparing cylindrical dowels and impacted wedges. Neurosurgery 51:1191–1198 (discussion 1198)PubMedCrossRef Barnes B, Rodts GE Jr, Haid RW Jr, Subach BR, McLaughlin MR (2002) Allograft implants for posterior lumbar interbody fusion: results comparing cylindrical dowels and impacted wedges. Neurosurgery 51:1191–1198 (discussion 1198)PubMedCrossRef
22.
Zurück zum Zitat Villavicencio AT, Burneikiene S, Bulsara KR, Thramann JJ (2006) Perioperative complications in transforaminal lumbar interbody fusion versus anterior-posterior reconstruction for lumbar disc degeneration and instability. J Spinal Disord Tech 19:92–97PubMedCrossRef Villavicencio AT, Burneikiene S, Bulsara KR, Thramann JJ (2006) Perioperative complications in transforaminal lumbar interbody fusion versus anterior-posterior reconstruction for lumbar disc degeneration and instability. J Spinal Disord Tech 19:92–97PubMedCrossRef
23.
Zurück zum Zitat Fantini GA, Pappou IP, Girardi FP, Sandhu HS, Cammisa FP Jr (2007) Major vascular injury during anterior lumbar spinal surgery: incidence, risk factors, and management. Spine (Phila Pa 1976) 32:2751–2758CrossRef Fantini GA, Pappou IP, Girardi FP, Sandhu HS, Cammisa FP Jr (2007) Major vascular injury during anterior lumbar spinal surgery: incidence, risk factors, and management. Spine (Phila Pa 1976) 32:2751–2758CrossRef
Metadaten
Titel
Neurologic deficit following lateral lumbar interbody fusion
verfasst von
Matthias Pumberger
Alexander P. Hughes
Russel R. Huang
Andrew A. Sama
Frank P. Cammisa
Federico P. Girardi
Publikationsdatum
01.06.2012
Verlag
Springer-Verlag
Erschienen in
European Spine Journal / Ausgabe 6/2012
Print ISSN: 0940-6719
Elektronische ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-011-2087-9

Weitere Artikel der Ausgabe 6/2012

European Spine Journal 6/2012 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Arthroskopie kann Knieprothese nicht hinauszögern

25.04.2024 Gonarthrose Nachrichten

Ein arthroskopischer Eingriff bei Kniearthrose macht im Hinblick darauf, ob und wann ein Gelenkersatz fällig wird, offenbar keinen Unterschied.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Ärztliche Empathie hilft gegen Rückenschmerzen

23.04.2024 Leitsymptom Rückenschmerzen Nachrichten

Personen mit chronischen Rückenschmerzen, die von einfühlsamen Ärzten und Ärztinnen betreut werden, berichten über weniger Beschwerden und eine bessere Lebensqualität.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.