Marios G Lykissas1, Alexander Aichmair2, Alexander P Hughes2, Andrew A Sama2, Darren R Lebl2, Fadi Taher2, Jerry Y Du2, Frank P Cammisa2, Federico P Girardi2. 1. Department of Orthopedic Surgery, Spine and Scoliosis Service, Hospital for Special Surgery, Weill Cornell Medical College, 535 East 70th St, New York, NY 10021, USA. Electronic address: mariolyk@yahoo.com. 2. Department of Orthopedic Surgery, Spine and Scoliosis Service, Hospital for Special Surgery, Weill Cornell Medical College, 535 East 70th St, New York, NY 10021, USA.
Abstract
BACKGROUND CONTEXT: Lateral lumbar interbody fusion (LLIF) has become an increasingly common minimally invasive procedure for selective degenerative deformity correction, reduction of low-grade spondylolisthesis, and indirect foraminal decompression. Concerns remain about the safety of the transpsoas approach to the spine due to proximity of the lumbosacral plexus. PURPOSE: To address risk factors for iatrogenic nerve injury in a large cohort of patients undergoing LLIF. STUDY DESIGN: Retrospective analysis of 919 LLIF procedures to identify risk factors for lumbosacral plexus injuries. METHODS: The medical charts of patients who underwent transpsoas interbody fusion with or without supplemental posterior fusion for degenerative spinal conditions over a 6-year period were retrospectively reviewed. Patients with prior lumbar spine surgery or follow-up of less than 6 months were excluded. Factors that may affect the neurologic outcome were investigated in a subset of patients who underwent stand-alone LLIF. RESULTS: Four hundred fifty-one patients (males/females: 179/272) met the inclusion criteria and were followed for a mean of 15 months (range, 6-53 months). Average age at the time of surgery was 63 years (range, 24-90 years). Average body mass index was 29 kg/m(2) (range, 17-65 kg/m(2)). A total of 919 levels were treated (mean, 2 levels per patient). Immediately after surgery, 38.5% of the patients reported anterior thigh/groin pain, whereas sensory and motor deficits were recorded in 38% and 23.9% of the patients, respectively. At the last follow-up, 4.8% of the patients reported anterior thigh/groin pain, whereas sensory and motor deficits were recorded in 24.1% and 17.3% of the patients, respectively. When patients with neural deficits present before surgery were excluded, persistent surgery-related sensory and motor deficits were identified in 9.3% and 3.2% of the patients, respectively. Among 87 patients with minimum follow-up of 18 months, persistent surgery-related sensory and motor deficits were recorded in 9.6% and 2.3% of the patients, respectively. Among patients with stand-alone LLIF, the level treated was identified as a risk factor for postoperative lumbosacral plexus injury. The use of recombinant human bone morphogenetic protein 2 was associated with persistent motor deficits. CONCLUSIONS: Although LLIF is associated with an increased prevalence of anterior thigh/groin pain as well as motor and sensory deficits immediately after surgery, our results support that pain and neurologic deficits decrease over time. The level treated appears to be a risk factor for lumbosacral plexus injury.
BACKGROUND CONTEXT: Lateral lumbar interbody fusion (LLIF) has become an increasingly common minimally invasive procedure for selective degenerative deformity correction, reduction of low-grade spondylolisthesis, and indirect foraminal decompression. Concerns remain about the safety of the transpsoas approach to the spine due to proximity of the lumbosacral plexus. PURPOSE: To address risk factors for iatrogenic nerve injury in a large cohort of patients undergoing LLIF. STUDY DESIGN: Retrospective analysis of 919 LLIF procedures to identify risk factors for lumbosacral plexus injuries. METHODS: The medical charts of patients who underwent transpsoas interbody fusion with or without supplemental posterior fusion for degenerative spinal conditions over a 6-year period were retrospectively reviewed. Patients with prior lumbar spine surgery or follow-up of less than 6 months were excluded. Factors that may affect the neurologic outcome were investigated in a subset of patients who underwent stand-alone LLIF. RESULTS: Four hundred fifty-one patients (males/females: 179/272) met the inclusion criteria and were followed for a mean of 15 months (range, 6-53 months). Average age at the time of surgery was 63 years (range, 24-90 years). Average body mass index was 29 kg/m(2) (range, 17-65 kg/m(2)). A total of 919 levels were treated (mean, 2 levels per patient). Immediately after surgery, 38.5% of the patients reported anterior thigh/groin pain, whereas sensory and motor deficits were recorded in 38% and 23.9% of the patients, respectively. At the last follow-up, 4.8% of the patients reported anterior thigh/groin pain, whereas sensory and motor deficits were recorded in 24.1% and 17.3% of the patients, respectively. When patients with neural deficits present before surgery were excluded, persistent surgery-related sensory and motor deficits were identified in 9.3% and 3.2% of the patients, respectively. Among 87 patients with minimum follow-up of 18 months, persistent surgery-related sensory and motor deficits were recorded in 9.6% and 2.3% of the patients, respectively. Among patients with stand-alone LLIF, the level treated was identified as a risk factor for postoperative lumbosacral plexus injury. The use of recombinant humanbone morphogenetic protein 2 was associated with persistent motor deficits. CONCLUSIONS: Although LLIF is associated with an increased prevalence of anterior thigh/groin pain as well as motor and sensory deficits immediately after surgery, our results support that pain and neurologic deficits decrease over time. The level treated appears to be a risk factor for lumbosacral plexus injury.
Authors: Christoph Mehren; H Michael Mayer; Christoph Zandanell; Christoph J Siepe; Andreas Korge Journal: Clin Orthop Relat Res Date: 2016-05-09 Impact factor: 4.176
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