Use of motor evoked potentials during lateral lumbar interbody fusion reduces postoperative deficits

Riley, Michael R.; Doan, Adam; Vogel, Richard; Aguirre, Alexander O.; Pieri, Kayla S.; Scheid, Edward H.

doi:10.1016/j.spinee.2018.02.024

Cited by 53 publications

(27 citation statements)

References 51 publications

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“…Medial to the transverse process, the round psoas muscle is palpated. EMG monitoring is used within psoas to avoid lumbar plexus [ 65 ]. Lateral fluoroscopy is utilized to ensure that the correct level is being accessed and the trajectory will be in a safe zone ( Fig.…”

Section: Lateral Lumbar Interbody Fusionmentioning

confidence: 99%

Lumbar Interbody Fusion: Techniques, Pearls and Pitfalls

Kim

Rhyu

et al. 2020

Asian Spine J

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Lumbar interbody fusion (LIF) is an effective and popular surgical procedure for the management of various spinal pathologies, especially degenerative diseases. Currently, LIF can be performed with posterior, transforaminal, anterior, and lateral approaches by open surgery or minimally invasive surgery (MIS). Each technique has its own advantages and disadvantages. In general, posterior LIF is a well-established procedure with good fusion rates and low complication rates but is limited by the possibility of iatrogenic injury to the neural structures and paraspinal muscles. Transforaminal LIF is frequently performed using an MIS technique and has an advantage of reducing these iatrogenic injuries. Anterior LIF (ALIF) can restore the disk height and sagittal alignment but has inherent approach-related challenges such as visceral and vascular complications. Lateral LIF and oblique LIF are performed using an MIS technique and have shown postoperative outcomes similar to ALIF; however, these approaches carry a risk of injury to psoas, lumbar plexus, and vascular structures. Herein, we provide a detailed description of the surgical procedures of each LIF technique. We shall then consider the pearls and pitfalls, as well as propose surgical indications and contraindications based on the available evidence in the literatures.

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Section: Lateral Lumbar Interbody Fusionmentioning

confidence: 99%

Lumbar Interbody Fusion: Techniques, Pearls and Pitfalls

Kim

Rhyu

et al. 2020

Asian Spine J

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“…Both of these studies are limited by the use of historical comparisons, but this topic clearly merits further study. Lastly, although intraoperative neuromonitoring of motor-evoked potentials has been found to be effective in preventing postoperative lumbar plexus deficits during LLIF, [19] its routine use is controversial [20].…”

Section: Thigh Symptomsmentioning

confidence: 99%

Lateral and Oblique Lumbar Interbody Fusion—Current Concepts and a Review of Recent Literature

Hah

Kang

2019

Curr Rev Musculoskelet Med

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Purpose To review the relevant recent literature regarding minimally invasive, lateral, and oblique approaches to the anterior lumbar spine, with a particular focus on the operative and postoperative complications. Methods A literature search was performed on Pubmed and Web of Science using combinations of the following keywords and their acronyms: lateral lumbar interbody fusion (LLIF), oblique lateral interbody fusion (OLIF), anterior-to-psoas approach (ATP), direct lateral interbody fusion (DLIF), extreme lateral interbody fusion (XLIF), and minimally invasive surgery (MIS). All results from January 2016 through January 2019 were evaluated and all studies evaluating complications and/or outcomes were included in the review. Recent Findings Transient neurological deficit, particularly sensorimotor symptoms of the ipsilateral thigh, remains the most common complication seen in LLIF. Best available current literature demonstrates that approximately 30-40% of patients have postoperative deficits, primarily of the proximal leg. Permanent symptoms are less common, affecting 4-5% of cases. Newer techniques to reduce this rate include different retractors, direct visualization of the nerves, and intraoperative neuromonitoring. OLIF may have lower deficit rates, but the available literature is limited. Subsidence rates in both LLIF and OLIF are comparable to ALIF (anterior lumbar interbody fusion), but further study is required. Supplemental posterior fixation is an active area of investigation that shows favorable biomechanical results, but additional clinical studies are needed. Summary Minimally invasive lumbar interbody fusion techniques continue to advance rapidly. As these techniques continue to mature, evidence-based risk-stratification systems are required to better guide both the patient and clinician in the joint decisionmaking process for the optimal surgical approach.

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“…Therefore, the authors decided to retrospectively study the result obtained by using neuromonitoring during transforaminal videoendoscopy in patients who were treated for herniated discs. While the three senior key opinion leader (KOL) surgeons (JFRL, ATY, and KUL) of this article have performed over 18,000 endoscopic spine surgeries between them [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ] under monitored local anesthesia care (MAC) and sedation [ 12 , 18 , 19 ] with minimal complications [ 1 , 20 ] and utilizing the patients’ direct intraoperative feedback to treat validated pain generators [ 11 , 15 , 19 , 21 , 22 ], they recognize that neuromonitoring in some countries and in some clinical settings is the standard of care [ 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ] in spite of added cost [ 33 ]. In some instances, it may even be a matter of necessity if MAC protocols for spine surgery are not supported by the local anesthesia teams.…”

Section: Introductionmentioning

confidence: 99%

Feasibility of Using Intraoperative Neuromonitoring in the Prophylaxis of Dysesthesia in Transforaminal Endoscopic Discectomies of the Lumbar Spine

Carvalho

Ramos

Meireles³

et al. 2020

Brain Sciences

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(1) Background: Postoperative nerve root injury with dysesthesia is the most frequent sequela following lumbar endoscopic transforaminal discectomy. At times, it may be accompanied by transient and rarely by permanent motor weakness. The authors hypothesized that direct compression of the exiting nerve root and its dorsal root ganglion (DRG) by manipulating the working cannula or endoscopic instruments may play a role. (2) Objective: To assess whether intraoperative neurophysiological monitoring can help prevent nerve root injury by identifying neurophysiological events during the initial placement of the endoscopic working cannula and the directly visualized video endoscopic procedure. (3) Methods: The authors performed a retrospective chart review of 65 (35 female and 30 male) patients who underwent transforaminal endoscopic decompression for failed non-operative treatment of lumbar disc herniation from 2012 to 2020. The patients’ age ranged from 22 to 86 years, with an average of 51.75 years. Patients in the experimental group (32 patients) had intraoperative neurophysiological monitoring recordings using sensory evoked (SSEP), and transcranial motor evoked potentials (TCEP), those in the control group (32 patients) did not. The SSEP and TCMEP data were analyzed and correlated to the postoperative course, including dysesthesia and clinical outcomes using modified Macnab criteria, Oswestry disability index (ODI), visual analog scale (VAS) for leg and back pain. (4) Results: The surgical levels were L4/L5 in 44.6%, L5/S1 in 23.1%, and L3/L4 in 9.2%. Of the 65 patients, 56.9% (37/65) had surgery on the left, 36.9% (24/65) on the right, and the remaining 6.2% (4/65) underwent bilateral decompression. Postoperative dysesthesia occurred in 2 patients in the experimental and six patients in the control group. In the experimental neuromonitoring group, there was electrodiagnostic evidence of compression of the exiting nerve root’s DRG in 24 (72.7%) of the 32 patients after initial transforaminal placement of the working cannula. A 5% or more decrease and a 50% or more decrease in amplitude of SSEPs and TCEPs recordings of the exiting nerve root were resolved by repositioning the working cannula or by pausing the root manipulation until recovery to baseline, which typically occurred within an average of 1.15 min. In 15 of the 24 patients with such latency and amplitude changes, a foraminoplasty was performed before advancing the endoscopic working cannula via the transforaminal approach into the neuroforamen to avoid an impeding nerve root injury and postoperative dysesthesia. (5) Conclusion: Neuromonitoring enabled the intraoperative diagnosis of DRG compression during the initial transforaminal placement of the endoscopic working cannula. Future studies with more statistical power will have to investigate whether employing neuromonitoring to avoid intraoperative compression of the exiting nerve root is predictive of lower postoperative dysesthesia rates in patients undergoing videoendoscopic transforaminal discectomy.

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Use of motor evoked potentials during lateral lumbar interbody fusion reduces postoperative deficits

Cited by 53 publications

References 51 publications

Lumbar Interbody Fusion: Techniques, Pearls and Pitfalls

Lumbar Interbody Fusion: Techniques, Pearls and Pitfalls

Lateral and Oblique Lumbar Interbody Fusion—Current Concepts and a Review of Recent Literature

Feasibility of Using Intraoperative Neuromonitoring in the Prophylaxis of Dysesthesia in Transforaminal Endoscopic Discectomies of the Lumbar Spine

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