Femoral nerve neuromonitoring for lateral lumbar interbody fusion surgery

Silverstein, Justin W.; Block, Jon E.; Smith, Michael L.; Bomback, David A.; Sanderson, Scott; Paul, Justin C.; Ball, Hieu T; Ellis, Jason A.; Goldstein, Matthew; Kramer, David L.; Arutyunyan, G. S.; Marcus, Joshua; Mermelstein, Sara; Slosar, Paul; Goldthwaite, Noel; Lee, Sun Ik; Reynolds, James B.; Riordan, Margaret; Pirnia, Nick; Kunwar, Sandeep; Hasan, Saqib; Bizzini, Bruce; Gupta, Sarita; Porter, Dorothy; Mermelstein, Laurence E.

doi:10.1016/j.spinee.2021.07.017

Cited by 12 publications

(5 citation statements)

References 34 publications

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“…Waiving those simple actions, patients experienced postoperative femoral nerve injuries. Making this an interesting tool for other surgical interventions as well [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Postoperative Femoral Nerve Palsy and Meralgia Paresthetica after Gynecologic Oncologic Surgery

Egger

Sezer

Condic

et al. 2022

JCM

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Femoral nerve palsy and meralgia paresthetica following gynecologic cancer surgery are rare, but severe and long lasting. Here, we aimed to study their incidence, severity, possible risk factors and its time to remission. Between January 2008 and December 2017 976 gynecologic cancer patients were identified in our institutional database receiving surgery. Complete patient charts were reviewed retrospectively. Possible risk factors were analyzed by Fisher’s exact test. 441 (45.18%) out 976 were treated for Ovarian cancer. In total 23 patients were identified with a postoperative neurological leg disorder. A femoral nerve palsy was present in 15 patients (1.5%) and a meralgia paresthetica in 8 patients (0.82%). Three patients showed both disorders. Duration of surgery (p = 0.0000), positioning during surgery (p = 0.0040), femoral artery catheter (p = 0.0051), prior chemotherapy (p = 0.0007), nicotine abuse (p = 0.00456) and prior polyneuropathy (p = 0.0181) showed a significant association with a postoperative femoral nerve palsy. Nicotine abuse (p = 0.0335) and prior chemotherapy (p = 0.0151) were significant for the development of a meralgia paresthetica. Long lasting surgery, patient positioning and femoral arterial catheter placement are risk factors for a postoperative femoral nerve palsy in gynecologic cancer surgery. Polyneuropathy, nicotine abuse, and prior chemotherapy are predisposing risk factors for a femoral nerve palsy and a meralgia paresthetica. A resolution of symptoms is the rule for both disorders within different time schedules.

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“…Waiving those simple actions, patients experienced postoperative femoral nerve injuries. Making this an interesting tool for other surgical interventions as well [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Postoperative Femoral Nerve Palsy and Meralgia Paresthetica after Gynecologic Oncologic Surgery

Egger

Sezer

Condic

et al. 2022

JCM

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“…Так, J.W. Silverstein с соавторами [24] и J.S. Uribe с соавторами [40] при выполнении бокового поясничного межтелового спондилодеза выявили снижение амплитуды вызванных потенциалов бедренного нерва во время хирургической ретракции, но незамедлительные хирургические контрмеры позволили смягчить либо предотвратить повреждение бедренного нерва.…”

Section: Discussionunclassified

“…Так, J.W. Silverstein с соавторами при мультимодальном мониторинге во время операции выявляли нарушение его проводимости в 11-12% случаев [24,25]. Другие авторы выявили высокую частоту развития в раннем послеоперационном периоде синдрома бедренного нерва, регистрируемого у 62,7% больных, который у части пациентов регрессировал через 3 мес., а у большинства лишь через год после операции [26,27].…”

Section: Introductionunclassified

Histological and Morphometric Changes in the Femoral Nerve During Lateral Interbody Fusion of the Lumbar Spine: Experimental Study

Варсегова

Дюрягина²,

Antonov³

et al. 2021

Traumatology and Orthopedics of Russia

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Neuropathies of the lumbar plexus trunks, in particular those of the femoral nerve, are the most common complications of lateral interbody spondylodesis of the lumbar spine. Modeling of this surgical intervention in normal animals experimentally makes it possible to assess the degree of its trauma to the nervous structures, and to understand what is the reason for the persistence or aggravation of neurological symptoms iatrogenic injuries or the existing pathology progression. Purpose of the Study. To study histological and morphometric changes in the femoral nerve in the long-term periods after modeling of the lateral interbody spondylodesis of the canine lumbar spine. Design of the Study. An experimental prospective continuous uncontrolled study. Material and Methods. Discectomy via lateral approach was performed in 18 mongrel dogs (aged 2-3 years, mass 13.2-17.6 kg) at the level of L4-5 и L5-6, interbody titanium implants were mounted, the lumbar spine was stabilized with a wire device for external fixation within 30 days. Clinical-and-neurological evaluation was performed, as well as histological investigation of the femoral nerves from the side of surgical approach. Results. In the early postoperative period a temporary decrease in the femoral nerve function was observed, which was manifested by the disorder of the support function and muscle weakness of the pelvic limbs, decrease in the knee reflex, the foot support shift to the metatarsal pad. Later, until the end of the study (18 months), the general condition of all animals was satisfactory, there were no disorders of the limb support function and motor reflexes. After six months, in the femoral nerve there was 4-fold decrease in the proportion of large fast-conducting myelin fibers D 10 m and 3-fold increase in that of the small ones. The mean axon diameter and myelin thickness were 62% and 53% of the norm. After 12-18 months, the dimensional characteristics of myelin fibers were restored. During the entire experiment, 4-6% of myelin fibers were reactively-and-destructively altered. Conclusions. The modeling of the lateral interbody spondylodesis of the lumbar spine in normal animals experimentally demonstrated the absence of neurological symptoms after 6-18 months, which indicated low invasiveness of the surgical intervention. Nevertheless, the subclinical reactive-and-destructive changes in the myelin fibers of the femoral nerve revealed 6 months after the surgery indicated the need for preventive anti-neurotic therapy.

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“…This modified splitting approach has proven to cause no femoral nerve damage at all by operating at the proper distance from the nerve. Neuromonitoring is essential for this procedure to detect the distance to the nerve and prevent nerve damage, as shown in the previous literature [19,20].…”

Section: Surgical Indication Criteria and Modified Surgical Approachmentioning

confidence: 92%

Elimination of Lumbar Plexus Injury by Changing the Entry Point and Traction Direction of the Psoas Major Muscle in Transpsoas Lateral Lumbar Spine Surgery

et al. 2023

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Background and Objectives: The lateral approach is commonly used for anterior column reconstruction, indirect decompression, and fusion in patients with lumbar degenerative diseases and spinal deformities. However, intraoperative lumbar plexus injury may occur. This is a retrospective comparative study to investigate and compare neurological complications between the conventional lateral approach and a modified lateral approach at L4/5. Materials and Methods: Patients with a lumbar degenerative disease requiring single-level intervertebral fusion at L4/5 were included and categorized into group X and group A. Patients in group X underwent conventional extreme lateral interbody fusion, while those in group A underwent a modified surgical procedure that included splitting of the anterior third of the psoas muscle, which was dilated by the retractor on the anterior third of the intervertebral disc. The incidence of lumbar plexus injury, defined as a decrease of ≥1 grade on manual muscle testing of hip flexors and knee extensors and sensory impairment of the thigh for ≥3 weeks, on the approach side, was investigated. Results: Each group comprised 50 patients. No significant between-group differences in age, sex, body mass index, and approach side were observed. There was a significant between-group difference in intraoperative neuromonitoring stimulation value (13.1 ± 5.4 mA in group X vs. 18.5 ± 2.3 mA in group A, p < 0.001). The incidence of neurological complications was significantly higher in group X than in group A (10.0% vs. 0.0%, respectively, p < 0.05). Conclusions: In our modified procedure, the anterior third of the psoas muscle was entered and split, and the intervertebral disc could be reached without damaging the lumbar plexus. When performing lumbar surgery using the lateral approach, lumbar plexus injury can be avoided by following surgical indication criteria based on the location of the lumbar plexus with respect to the psoas muscle and changing the transpsoas approach to the intervertebral disc.

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Femoral nerve neuromonitoring for lateral lumbar interbody fusion surgery

Cited by 12 publications

References 34 publications

Postoperative Femoral Nerve Palsy and Meralgia Paresthetica after Gynecologic Oncologic Surgery

Postoperative Femoral Nerve Palsy and Meralgia Paresthetica after Gynecologic Oncologic Surgery

Histological and Morphometric Changes in the Femoral Nerve During Lateral Interbody Fusion of the Lumbar Spine: Experimental Study

Elimination of Lumbar Plexus Injury by Changing the Entry Point and Traction Direction of the Psoas Major Muscle in Transpsoas Lateral Lumbar Spine Surgery

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