title: Neurological complications using a novel retractor system for direct lateral minimally invasive lumbar interbody fusion.
abstract: We describe our experience using the RAVINE retractor (K2M, Leesburg, VA, USA) to gain access to the lateral aspect of the lumbar spine through a retroperitoneal approach. Postoperative neurological adverse events, utilising the mentioned retractor system, were recorded and analysed. We included 140 patients who underwent minimally invasive lateral lumbar interbody fusion (MI-LLIF) for degenerative spinal conditions between 2011 and 2015 at two major spinal centres. A total of 228 levels were treated, 35% one level, 40% two level, 20% three level and 5% 4 level surgeries. The L4/5 level was instrumented in 28% of cases. 12/140 patients had postoperative neurological complications. Immediately after surgery, 5% of patients (7/140) had transient symptoms in the thigh ranging from sensory loss, pain and paraesthesia, all of which recovered within 12weeks following surgery. There were five cases of femoral nerve palsy (3.6% - two ipsilateral and three contralateral), all of which recovered completely with no residual sensory or motor deficit within 6months. MI-LLIF done with help of the described retractor system has proved a safe and efficient way to achieve interbody fusion with minimal complications, mainly nerve related, that recovered quickly. Judicious use of the technique to access the L4/5 level is advised.
authors.affiliation: Spinal Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK. Electronic address: fadysedra@ymail.com.
authors.forename: Fady
authors.initials: F
authors.lastname: Sedra
authors.affiliation: Spinal Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK.
authors.forename: Robert
authors.initials: R
authors.lastname: Lee
authors.affiliation: Spinal Unit, Clinico San Carlos Hospital, Madrid 28040, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Dominguez
authors.affiliation: Spinal Unit, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex HA7 4LP, UK.
authors.forename: Lester
authors.initials: L
authors.lastname: Wilson
mesh_terms: D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation* / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000295:instrumentation* / Q000379:methods*
keywords: Complications; Lateral interbody fusion; Neurological