Postoperative lumbar plexus injury after lumbar retroperitoneal transpsoas minimally invasive lateral interbody fusion.
METHODS
Retrospective review.


OBJECTIVE
To evaluate the motor and sensory deficit rate after the lumbar retroperitoneal transpsoas minimally invasive lateral interbody fusion (MIS LIF) by reviewing a single surgeon's experience.


BACKGROUND
The MIS LIF is an increasingly used alternative to traditional open anterior or posterior operations to treat a host of spinal disorders. It has many advantages, but the potential for immediate postoperative thigh numbness, pain, and potential motor weakness has been reported. Published rates range widely in part because previous studies have based patient outcomes on data from different surgeons using different techniques.


METHODS
An institutional review board-approved, retrospective review of a prospectively collected database was conducted. Seventy-one consecutive patients who underwent this procedure between L1 and L5 during a 3-year period met criteria and were included. Postoperative clinical examinations immediately after surgery and during routine follow-up intervals were examined.


RESULTS
There was a 19.1% (14/71) rate of immediate postoperative ipsilateral thigh numbness during the study period. The annual rates of numbness progressively decreased annually. There was a 26.1% (6/23), 25% (5/20), and 10.7% (3/28) rate for 2008, 2009, and 2010, respectively. All patients with numbness had a fusion construct that involved L4-L5. More than half the patients, 54.9% (39/71), had immediate postoperative ipsilateral iliopsoas or quadriceps weakness. Of these, the vast majority had resolution by 3 months (92.3%), and all had complete resolution by 2 years.


CONCLUSIONS
The lumbar retroperitoneal transpsoas MIS LIF is a safe alternative to traditional open operations for many spinal conditions. As with most minimally invasive techniques, there is a learning curve to be overcome to minimize the risk of iatrogenic nerve injuries. Our refined technique of the MIS LIF during a 3-year period has led to a significant reduction of the incidence of postoperative numbness of nearly 60% (from 26.1%-10.7%).
Department of Neurosurgery and Brain Repair, Morsani College of Medicine, University of South Florida, Tampa, FL 33606, USA. tienvle77@gmail.com
Tien V
TV
Le
Clinton J
CJ
Burkett
Armen R
AR
Deukmedjian
Juan S
JS
Uribe
D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006987:Hypesthesia / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D007403:Intervertebral Disc / Q000473:pathology / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery*; D008160:Lumbosacral Plexus / Q000293:injuries* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D011446:Prospective Studies; D012187:Retroperitoneal Space / Q000601:surgery; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods*