Jonathan N Sellin1, G Damian Brusko1, Allan D Levi2. 1. Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA. 2. Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA. Electronic address: ALevi@med.miami.edu.
Abstract
OBJECTIVE: To discuss lessons learned from an initial lateral lumbar interbody fusion (LLIF) experience with a focus on evolving surgical technique, complication avoidance, and new motor and sensory outcomes after implementation of a modified surgical approach. METHODS: A retrospective analysis of a prospectively collected series of all patients undergoing LLIF by the senior author (A.D.L.) from January 2010 to January 2018 after implementation of a modified surgical mini-open technique, compared with previously reported institutional results with the originally recommended percutaneous technique. LLIF-specific complications examined included groin/thigh sensory dysfunction, flank bulge/pseudohernia, psoas-pattern weakness, and femoral nerve injury. RESULTS: The incidence (19%, n = 98 patients) of groin/thigh sensory dysfunction in our cohort was significantly lower than that of the historical control (60%, n = 59) (P < 0.0001). The incidence of abdominal flank bulge/pseudohernia (2.0%, n = 98 patients) in our cohort was improved but not significantly lower than that of the historical control (4.2%, n = 118) (P = 0.36). The incidence of psoas-pattern weakness (3.1%, n = 98) in our cohort was significantly lower than that of the historical control (23.7%, n = 59) (P = 0.0001). The incidence of femoral nerve injury (0%, n = 98 patients) in our cohort was improved but was not significantly lower than that of the historical control (1.7%, n = 118) (P = 0.20). CONCLUSIONS: The adoption of an exclusive mini-open muscle-splitting approach with first-look inspection of the lumbosacral plexus nerve elements may improve motor and sensory outcomes in general and the incidence of postoperative groin/thigh sensory dysfunction and psoas-pattern weakness in particular.
OBJECTIVE: To discuss lessons learned from an initial lateral lumbar interbody fusion (LLIF) experience with a focus on evolving surgical technique, complication avoidance, and new motor and sensory outcomes after implementation of a modified surgical approach. METHODS: A retrospective analysis of a prospectively collected series of all patients undergoing LLIF by the senior author (A.D.L.) from January 2010 to January 2018 after implementation of a modified surgical mini-open technique, compared with previously reported institutional results with the originally recommended percutaneous technique. LLIF-specific complications examined included groin/thigh sensory dysfunction, flank bulge/pseudohernia, psoas-pattern weakness, and femoral nerve injury. RESULTS: The incidence (19%, n = 98 patients) of groin/thigh sensory dysfunction in our cohort was significantly lower than that of the historical control (60%, n = 59) (P < 0.0001). The incidence of abdominal flank bulge/pseudohernia (2.0%, n = 98 patients) in our cohort was improved but not significantly lower than that of the historical control (4.2%, n = 118) (P = 0.36). The incidence of psoas-pattern weakness (3.1%, n = 98) in our cohort was significantly lower than that of the historical control (23.7%, n = 59) (P = 0.0001). The incidence of femoral nerve injury (0%, n = 98 patients) in our cohort was improved but was not significantly lower than that of the historical control (1.7%, n = 118) (P = 0.20). CONCLUSIONS: The adoption of an exclusive mini-open muscle-splitting approach with first-look inspection of the lumbosacral plexus nerve elements may improve motor and sensory outcomes in general and the incidence of postoperative groin/thigh sensory dysfunction and psoas-pattern weakness in particular.
Authors: Alexander O Aguirre; Mohamed A R Soliman; Shady Azmy; Asham Khan; Patrick K Jowdy; Jeffrey P Mullin; John Pollina Journal: Neurosurg Rev Date: 2021-12-01 Impact factor: 3.042