title: More nerve root injuries occur with minimally invasive lumbar surgery: Let's tell someone.
abstract: BACKGROUND
  In a recent study entitled: "More nerve root injuries occur with minimally invasive lumbar surgery, especially extreme lateral interbody fusion (XLIF): A review", Epstein documented that more nerve root injuries occurred utilizing minimally invasive surgery (MIS) versus open lumbar surgery for diskectomy, decompression of stenosis (laminectomy), and/or fusion for instability.
  
  
  METHODS
  In large multicenter Spine Patient Outcomes Research Trial reviews performed by Desai et al., nerve root injury with open diskectomy occurred in 0.13-0.25% of cases, occurred in 0% of laminectomy/stenosis with/without fusion cases, and just 2% for open laminectomy/stenosis/degenerative spondylolisthesis with/without fusion.
  
  
  RESULTS
  In another MIS series performed largely for disc disease (often contained nonsurgical disc herniations, therefore unnecessary procedures) or spondylolisthesis, the risk of root injury was 2% for transforaminal lumbar interbody fusion (TLIF) versus 7.8% for posterior lumbar interbody fusion (PLIF). Furthermore, the high frequencies of radiculitis/nerve root/plexus injuries incurring during anterior lumbar interbody fusions (ALIF: 15.8%) versus extreme lumbar interbody fusions (XLIF: 23.8%), addressing disc disease, failed back surgery, and spondylolisthesis, were far from acceptable.
  
  
  CONCLUSIONS
  The incidence of nerve root injuries following any of the multiple MIS lumbar surgical techniques (TLIF/PLIF/ALIF/XLIF) resulted in more nerve root injuries when compared with open conventional lumbar surgical techniques. Considering the majority of these procedures are unnecessarily being performed for degenerative disc disease alone, spine surgeons should be increasingly asked why they are offering these operations to their patients?
authors.affiliation: Department of Winthrop NeuroScience, Winthrop University Hospital, Mineola, New York, USA.
authors.forename: Nancy E
authors.initials: NE
authors.lastname: Epstein
keywords: Extreme lateral interbody fusion (XLIF); lumbar surgery; minimally invasive surgery (MIS); nerve root injuires; percutaneous procedures; posterior lumbar interbody fusion (PLIF); posterolateral fusions (PLF); transforaminal lumbar interbody fusion (TLIF)