Functional recovery of severe obturator and femoral nerve injuries after lateral retroperitoneal transpsoas surgery

Case report

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The minimally invasive lateral retroperitoneal transpsoas approach is a popular fusion technique. However, potential complications include injury to the lumbar plexus nerves, bowel, and vasculature, the most common of which are injuries to the lumbar plexus. The femoral nerve is particularly vulnerable because of its size and location; injury to the femoral nerve has significant clinical implications because of its extensive sensory and motor innervation of the lower extremities. The authors present an interesting case of a 49-year-old male patient in whom femoral and obturator nerve functional recovery unexpectedly occurred 364 days after the nerves had been injured during lateral retroperitoneal transpsoas surgery. Chronological video and electrodiagnostic findings demonstrate evidence of recovery. Classification and mechanisms of nerve injury and nerve regeneration are discussed.

Abbreviations used in this paper:EMG = electromyography; LIF = lumbar interbody fusion; MIS = minimally invasive surgery; MRC = Medical Research Council; SASD = small-amplitude, short-duration.

Article Information

Address correspondence to: Juan Uribe, M.D., Department of Neurosurgery, University of South Florida, 2 Tampa General Circle, USF Health, 7th Floor, Tampa, Florida 33606. email: juansuribe@gmail.com.

Please include this information when citing this paper: published online February 22, 2013; DOI: 10.3171/2013.1.SPINE12958.

© AANS, except where prohibited by US copyright law.

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Figures

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    Sensory deficit. Pictorial representation of the sensory deficits outlined by the patient 4 months after the injury. The deficits represent both the obturator and femoral nerve sensory cutaneous dermatomes. Furthermore, muscle atrophy is also noted in the right lower extremity.

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    Postoperative imaging. Immediate postoperative MR image (A) showing signal change in the posterior aspect of the psoas muscle; radiograph (B) and CT image (C) showing interbody spacer at the mid–vertebral body on the sagittal view.

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