Anterior Thigh Pain Following Minimally Invasive Oblique Lateral Interbody Fusion: Multivariate Analysis from a Prospective Case Series

Abstract

Background Oblique lateral interbody fusion (OLIF) involves the antepsoas approach and psoas major muscle (PMM) retraction to insert the interbody cage orthogonally. Therefore, OLIF is often associated with postoperative anterior thigh pain (ATP) on the approach side. However, there is limited evidence on the nature and risk factors of ATP following OLIF. Methods Consecutive patients who planned to undergo minimally invasive OLIF and percutaneous pedicle screw instrumentation for lumbar degenerative diseases were prospectively enrolled. The visual analog scale (VAS) for ATP was recorded, and a pain map was drawn daily from the operation day to postoperative day 7 in all patients. We also prospectively collected the preoperative and intraoperative data to identify the risk factors associated with ATP. Radiologically, the total cross-sectional area (CSA), retraction length, and retraction CSA of PMM were measured from the preoperative T2-weighted axial magnetic resonance imaging scans at the L4–5 intervertebral disc level. The patients were stratified into two groups based on the experience of ATP with a VAS score of ≥ 7 at any time point. Additionally, a binary logistic regression analysis was performed to identify the associated factors. Results The current prospective study included 92 patients (31 men, 61 women) with a mean age of 70.4 years (range, 56–86 years), who underwent OLIF at our institution. The left-side approach was used in 73 patients (79.3%), while 19 (20.7%) underwent a right-side approach. Sixty-five of the total patients (70.6%) experienced approach-side ATP to any extent during postoperative 0–7 days following OLIF. The mean pain VAS (4.4 ± 2.1) and the prevalence (57.6%) were highest at postoperative 2 days. On postoperative day 7, there were 19 patients (20.7%) who complained of residual ATP with a mean VAS of 2.6 ± 1.8. In the multivariate analysis, the PMM retraction length was significantly associated with ATP of VAS ≥ 7 (adjusted odds ratio, 2.316; p = 0.044). Conclusions In this study, we prospectively collected and analyzed the ATP and associated factors following OLIF and identified the PMM retraction length as a potential independent risk factor for severe ATP in the immediate postoperative period following OLIF. Keywords: Anterior thigh pain, Psoas major muscle, Antepsoas, Oblique lateral interbody fusion, Genitofemoral nerve

Effect Of Unintended Tissue Injury On The Development Of Thigh Symptoms After Lateral Lumbar Interbody Fusion In Patients With Adult Spinal Deformity

“…However, our results indicate that hematoma in the psoas major muscle and cage malposition were associated with the development of thigh symptoms and muscle weakness, respectively. Although Chang et al 21 reported that cage subsidence was more frequent in patients with thigh pain (27.5% vs. 11.9%), no association with thigh symptoms was found in our investigation.…”

“…Surgery at the L4/5 level 15–17 and surgical duration 18,19 were previously reported as factors associated with the development of thigh symptoms. Other reports indicate that the L2/3 level, thinning of the psoas major muscle, and retraction time on the psoas major muscle are the risk factors for thigh paresthesia, 20 thigh sensory change, 13 and severe thigh pain 21 . However, our results indicate that hematoma in the psoas major muscle and cage malposition were associated with the development of thigh symptoms and muscle weakness, respectively.…”

“…Other reports indicate that the L2/3 level, thinning of the psoas major muscle, and retraction time on the psoas major muscle are the risk factors for thigh paresthesia, 20 thigh sensory change, 13 and severe thigh pain. 21 However, our results indicate that hematoma in the psoas major muscle and cage malposition were associated with the development of thigh symptoms and muscle weakness, respectively. Although Chang et al 21 reported that cage subsidence was more frequent in patients with thigh pain (27.5% vs. 11.9%), no association with thigh symptoms was found in our investigation.…”

An Expanded Surgical Corridor of Oblique Lateral Interbody Fusion at L4–5: A Magnetic Resonance Imaging Study

“…26,27 The amount of psoas muscle retraction is also reported to be associated with the anterior thigh symptom in OLIF at the L4-5 level. 28 Aggressive and prolonged retraction may cause more severe postoperative anterior thigh symptoms. Care should be taken during the psoas muscle manipulation in order to expose the targeted intervertebral disc.…”

The Evolution of Lateral Lumbar Interbody Fusion: A Journey from Past to Present

“…Other intraoperative complications, which occur in less than 1% of cases, include major vascular injury, vertebral body fracture, membrane laceration, and ureteral injury. The most common immediate postoperative complications are transient numbness or pain in the lower limbs, as well as temporary weakness and nerve deficits arising from sympathetic trunk injury [ 127 , 128 ]. However, a review demonstrated significant benefits via a modified OLIF procedure through the anteroinferior psoas approach that resulted in reduced psoas and neurovascular injury, as well as improved pain scores [ 129 ].…”