Nerve monitoring changes related to iliac artery compression during anterior lumbar spine surgery

Brau, Salvador A.; Spoonamore, Mark J.; Snyder, Lance; Gilbert, Constance; Rhonda, Georgia; Williams, Lytton; Watkins, Robert G.

doi:10.1016/s1529-9430(03)00067-6

Cited by 52 publications

(11 citation statements)

References 10 publications

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“…The appropriateness of the transpsoas lumbar interbody fusion for multilevel fusions was questioned in the early introduction of its use due to the increased potential for complications. 3 Compressive neuropathy has been shown to be caused by patient hip positioning, 19,25 retractor compression, 2,3,12,19,25 hematoma, 13,17 and ischemic insult, 4 resulting in postoperative thigh symptoms. Although nerve compression from a single-level procedure may be minimal, multilevel procedures place repeated strain on surrounding structures for a longer period of time, increasing the risk for nerve damage.…”

Section: Discussionmentioning

confidence: 99%

An analysis of postoperative thigh symptoms after minimally invasive transpsoas lumbar interbody fusion

Cummock

Vanni

Levi

et al. 2011

SPI

212

127

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Object The minimally invasive transpsoas interbody fusion technique requires dissection through the psoas muscle, which contains the nerves of the lumbosacral plexus posteriorly and genitofemoral nerve anteriorly. Retraction of the psoas is becoming recognized as a cause of transient postoperative thigh pain, numbness, paresthesias, and weakness. However, few reports have described the nature of thigh symptoms after this procedure. Methods The authors performed a review of patients who underwent the transpsoas technique for lumbar spondylotic disease, disc degeneration, and spondylolisthesis treated at a single academic medical center. A review of patient charts, including the use of detailed patient-driven pain diagrams performed at equal preoperative and follow-up intervals, investigated the survival of postoperative thigh pain, numbness, paresthesias, and weakness of the iliopsoas and quadriceps muscles in the follow-up period on the ipsilateral side of the surgical approach. Results Over a 3.2-year period, 59 patients underwent transpsoas interbody fusion surgery. Of these, 62.7% had thigh symptoms postoperatively. New thigh symptoms at first follow-up visit included the following: burning, aching, stabbing, or other pain (39.0%); numbness (42.4%); paresthesias (11.9%); and weakness (23.7%). At 3 months postoperatively, these percentages decreased to 15.5%, 24.1%, 5.6%, and 11.3%, respectively. Within the patient sample, 44% underwent a 1-level, 41% a 2-level, and 15% a 3-level transpsoas operation. While not statistically significant, thigh pain, numbness, and weakness were most prevalent after L4–5 transpsoas interbody fusion at the first postoperative follow-up. The number of lumbar levels that were surgically treated had no clear association with thigh symptoms but did correlate directly with surgical time, intraoperative blood loss, and length of hospital stay. Conclusions Transpsoas interbody fusion is associated with high rates of immediate postoperative thigh symptoms. While larger, prospective studies are necessary to validate these findings, the authors found that half of the patients had symptom resolution at approximately 3 months postoperatively and more than 90% by 1 year.

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Section: Discussionmentioning

confidence: 99%

An analysis of postoperative thigh symptoms after minimally invasive transpsoas lumbar interbody fusion

Cummock

Vanni

Levi

et al. 2011

SPI

212

127

View full text Add to dashboard Cite

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“…3 Intraoperative image showing a composite graft, ePTFE plus autologous vein, used to reconstruct the posterior tibial artery measurements can help to detect undue compression on the artery or thrombosis. SSEP monitoring and SaO2 measurements have also been employed for early detection of such complications [15]. Both methods were in agreement since loss of SaO2 was contemporary with loss of SSEP, suggesting also temporary nerve root ischaemia.…”

Section: Procedure-specific Complicationsmentioning

confidence: 78%

Vascular complications of orthopaedic surgery: an update on diagnosis and management

Benedetti-Valentini

Villani

Laurito

et al. 2006

J Orthopaed Traumatol

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Vascular complications in orthopaedic surgery are not frequent, but they can be severe and occasionally life-threatening. Present technologies make it easier to detect and successfully manage them, provided a high level of clinical suspicion is kept. Spontaneous complication is deep venous thrombosis (DVT), which occurs in 2.5% of patients undergoing hip or knee arthroplasty and can be treated by prophylactic doses of low molecular weight heparin (LMWH). D-Dimer blood test and duplex scanning are the pillars of diagnosis. LMWH (6000 U twice daily) is standard therapy but in selected cases thrombolysis or surgical venous thrombectomy can be used. Iatrogenic complications come from surgical manoeuvres and instruments; risk factors are preexisting atheromatous lesions and reinterventions, both orthopaedic and vascular. These lesions can cause bleeding, ischaemia, embolism, pseudoaneurysms or arteriovenous fistula, and are classified accordingly. Diagnosis is done by duplex scanning, computed tomography or angiography (particularly intraoperative angiography) and should be timely in order to allow the earliest possible management. This is crucial for a successful result, which may avoid damage to the patient and medicolegal problems. District-specific complications and treatment are reviewed.

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“…Arterial injury is significantly more rare [3][4][5][6]. Brau reported an incidence of common iliac artery (CIA) injury of only 0.45% in their series of 1,315 anterior procedures [7]. In the 16 reported cases of CIA injury in literature, 15 were left sided and most were at the L4-5 level [1].…”

Section: Discussionmentioning

confidence: 99%

Left iliac artery injury during anterior lumbar spine surgery diagnosed by intraoperative neurophysiological monitoring

et al. 2010

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Serious vascular injury is a rare, but potentially devastating complication during anterior lumbar spinal surgery. The authors describe the first reported case where vascular injury was detected by multimodality neurophysiological monitoring during an L3-S1 anterior lumbar interbody fusion. The case demonstrates the need for multimodality monitoring and the combined use of somatosensory-evoked potentials and motor-evoked potentials.

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Nerve monitoring changes related to iliac artery compression during anterior lumbar spine surgery

Cited by 52 publications

References 10 publications

An analysis of postoperative thigh symptoms after minimally invasive transpsoas lumbar interbody fusion

An analysis of postoperative thigh symptoms after minimally invasive transpsoas lumbar interbody fusion

Vascular complications of orthopaedic surgery: an update on diagnosis and management

Left iliac artery injury during anterior lumbar spine surgery diagnosed by intraoperative neurophysiological monitoring

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