Skip to main content

Advertisement

SpringerLink
Log in

Lumbar plexopathy following instrumented posterior lumbar interbody fusion: a complication with use of Hohmann’s retractor

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Introduction

A series of 12 patients in our centre following single level instrumented posterior lumbar interbody fusion at L4–L5 developed unexplainable motor weakness in the proximal lumbar nerve roots (L2, L3) and numbness of the whole limb, a clinical picture resembling lumbar plexopathy. Even though lumbar plexopathy has been reported following gynaecological procedures and in transpsoas interbody fusion surgeries, there is no literature reporting this complication following conventional instrumented posterior lumbar interbody fusions.

Study design

Retrospective observational study.

Objective

To find the possible mechanism of development of lumbar plexopathy in patients who underwent posterior lumbar interbody fusion surgeries in our centre.

Material and methods

We analyzed retrospectively the medical records, electrophysiological reports of the patients, literatures on the anatomy of lumbar plexus and other literature reporting similar complications. We also dissected lumbar plexus of three cadavers and simulated surgical technique on them to find the mechanism of development of this unusual complication.

Results

We found injury to lumbar plexus that probably occurred intraoperatively with Hohmann’s retractor that was used for retraction of the paraspinal muscles. This theory was favoured by many clinical factors and further confirmed by cadaveric dissections.

Conclusion

We conclude that surgical technique with improper use of Hohmann’s retractor causes traction and compression injury to the lumbar plexus resulting in this complication. We propose proper technique of insertion of Hohmann’s retractor and also recommend use of modified Hohmann’s retractor with shorter tips for spinal procedures to prevent such complication.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. The Lumbosacral plexus: Gray’s anatomy of the human body: Yahoo! Education [Internet] Available from: http://education.yahoo.com/reference/gray/subjects/subject/212, [cited 2012 Jan 28]

  2. Lumbosacral plexus syndromes [Internet] Available from: http://www.uptodate.com/contents/lumbosacral-plexus-syndromes#H23, [cited 2012 Jan 28]

  3. John DA (1996) Lumbosacral plexopathy after gynecologic surgery: case report and review of the literature. Am J Obstet Gynecol 174(6):1769–1778 [cited 2012 Jan 28]

    Article  Google Scholar 

  4. pdf_JTN_71.pdf [Internet] Available from: http://neurosurgery.dergisi.org/pdf/pdf_JTN_71.pdf, [cited 2012 Jan 28]

  5. Davis TT, Bae HW, Mok MJM, Rasouli A, Delamarter RB. Lumbar Plexus Anatomy within the Psoas Muscle: Implications for the Transpsoas Lateral Approach to the L4-L5 Disc [Internet]. JBJS Available from: http://www.jbjs.org/article.aspx?articleid=35681, [cited 2012 Jan 28]

  6. Gupta A, Muzumdar D, Ramani PS (2004) Meralgia paraesthetica following lumbar spine surgery: a study in 110 consecutive surgically treated cases. Neurol India 52(1):64–66 [cited 2012 Jan 28]

    PubMed  CAS  Google Scholar 

  7. Aebi M, Arlet V, Webb JK (2007) AO spine manual. Thieme

  8. Mayer HM (2005) Minimally invasive spine surgery: A surgical manual. Birkhäuser

  9. Lu S, Chang S, Zhang YZ, Ding ZH, Xu XM, Xu YQ (2011) Clinical anatomy and 3D virtual reconstruction of the lumbar plexus with respect to lumbar surgery. BMC Musculoskelet Disord 12:76 [cited 2012 Jan 29]

    Article  PubMed  Google Scholar 

  10. Ditunno JF Jr, Young W, Donovan WH, Creasey G (1994) The international standards booklet for neurological and functional classification of spinal cord injury. American spinal injury association. Paraplegia 32(2):70–80 [cited 2012 Sep 29]

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank G. Rajkumar, Artist cum Modeller, Department of Anatomy, Christian Medical College, for the drawing provided by him for this paper.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Spinal Disorder Surgery Unit, Department of Orthopaedics and Department of Anatomy, Christian Medical College, 632004, Vellore, Tamil Nadu, India

    Vijay Sekharappa, Ivan James, Rohit Amritanand, K. Venkatesh & Kenny S. David

Authors
  1. Vijay Sekharappa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ivan James
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rohit Amritanand
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. K. Venkatesh
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kenny S. David
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Vijay Sekharappa.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sekharappa, V., James, I., Amritanand, R. et al. Lumbar plexopathy following instrumented posterior lumbar interbody fusion: a complication with use of Hohmann’s retractor. Eur Spine J 22, 2039–2046 (2013). https://doi.org/10.1007/s00586-013-2748-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-013-2748-y

Keywords

Search

Navigation