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

Abstract

<jats:p>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.</jats:p>

Postoperative Complications Within the First Year After Extreme Lateral Interbody Fusion

“…25 As in our study, other authors have reported at least some recovery of quadriceps function between 1-1 1/2 years after surgery. 24,26,27 However, Cahill et al found no motor function recovery at 1 year in 2 patients who underwent an XLIF at L4-5, while Sofianos reported only 1 of 3 patients with postoperative quadriceps weakness had a complete recovery at 20 months. 25,28 Several anatomic studies have shown that the femoral nerve lies closer in proximity to the ideal discectomy site at the L4-5 disc space than the more cephalad intervertebral levels and hence the femoral nerve is prone to injury at this level.…”

Iatrogenic femoral nerve injuries: analysis of medico-legal issues through a scoping review approach

“…Although the role of intraoperative EMG monitoring is indispensable, its diagnostic ability might be overestimated, as plexic lesions are mostly multifactorial [ 54 ].…”

“…Several possible mechanisms of damage are described: excessive stretching, direct compression or compression by haematoma of the psoas, displacement of an endplate fragment, and postoperative herniation [ [51] , [52] , [53] , [54] , [55] ].…”

Prevention of neurological complications using a neural monitoring system with a finger electrode in the extreme lateral interbody fusion approach

“…[1][2][3]9,12,[16][17][18]21,24 Reduction of neurological complications is likely to improve the surgical outcome of XLIF and expand the indication. For this reason, we developed a new neural monitoring system using a finger electrode to reach the intervertebral region in patients undergoing XLIF.…”