Motor nerve injuries following the minimally invasive lateral transpsoas approach

Clinical article

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Object

The aim of this study was to determine the incidence of motor nerve injuries during the minimally invasive lateral interbody fusion procedure at a single academic medical center.

Methods

A retrospective chart review of 118 patients who had undergone lateral interbody fusion was performed. Both inpatient and outpatient records were examined to identify any new postoperative motor weakness in the lower extremities and abdominal wall musculature that was attributable to the operative procedure.

Results

In the period from 2007 to 2011 the lateral interbody fusion procedure was attempted on 201 lumbar intervertebral disc levels. No femoral nerve injuries occurred at any disc level other than the L4–5 disc space. Among procedures involving the L4–5 level there were 2 femoral nerve injuries, corresponding to a 4.8% injury risk at this level as compared with a 0% injury risk at other lumbar spine levels. Five patients (4.2%) had postoperative abdominal flank bulge attributable to injury to the abdominal wall motor innervation.

Conclusions

The overall incidence of femoral nerve injury after the lateral transpsoas approach was 1.7%; however, the level-specific incidence was 4.8% for procedures performed at the L4–5 disc space. Approximately 4% of patients had postoperative abdominal flank bulge. Surgeons will be able to minimize these motor nerve injuries through judicious use of the procedure at the L4–5 level and careful attention to the T-11 and T-12 motor nerves during exposure and closure of the abdominal wall.

Abbreviation used in this paper:EMG = electromyography.

Article Information

Address correspondence to: Allan D. Levi, M.D., Ph.D., Department of Neurological Surgery, University of Miami Miller School of Medicine, Lois Pope LIFE Center, 2nd Floor, 1095 NW 14th Terrace (D4-6), Miami, Florida 33136. email: ALevi@med.miami.edu.

Please include this information when citing this paper: published online June 29, 2012; DOI: 10.3171/2012.5.SPINE1288.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Photograph showing new postoperative left-sided abdominal flank bulge in a patient who underwent a left-sided minimally invasive lateral interbody fusion.

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    Photograph of a representative patient with persistent left quadriceps muscle weakness and atrophy.

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    Immediate postoperative (A–C) and 1-year postoperative (D–F) abdominal CT scans obtained in a patient who demonstrated a permanent postoperative abdominal flank bulge. The patient underwent a 3-level minimally invasive lateral interbody fusion from L-1 to L-4 via a left-sided approach. Arrows indicate significant thinning and dilation of the abdominal musculature that extends anteriorly from the surgical site. The average thickness of the abdominal wall musculature on the surgical approach side is approximately 5 mm less than on the contralateral side.

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