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Monitoring lumbar plexus integrity in extreme lateral transpsoas approaches to the lumbar spine: a new protocol with anatomical bases

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Abstract

XLIF is an increasingly popular procedure that requires traversing the psoas, with the potential risk of injuring the lumbar plexus nerves. Intraoperative neurophysiological monitoring (IOM) is, therefore, critical in this kind of procedures; nevertheless, there were some reports of neural damage.

Purpose

To determine the effectiveness of a new protocol for IOM during XLIF.

Materials and methods

This prospective, nonrandomized, institutional review board-approved study enrolled adult patients of both sexes undergoing XLIF at the Italian Hospital of Buenos Aires between 2012 and 2014. Preoperative and immediate postoperative neurological examinations were carried out, paying special attention to lumbar plexus motor and sensory territories. IOM included EMG and transpsoas stimulation, considering the territories of every motor and sensory branch of the lumbar plexus.

Results

107 patients (133 lumbar levels) were evaluated. Reproducible responses were obtained in the collateral and terminal branches of the lumbar plexus, which were well preserved. No patient (0 %) had new motor postoperative deficits. Nineteen (17.75 %) patients had minor and transient sensory symptoms, lasting less than a month. One patient (0.93 %) had longer duration of sensory complaints (3 months).

Conclusion

A detailed IOM of lumbar plexus branches can determine in real time the proximity of intrapsoas nerves during XLIF.

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Authors and Affiliations

  1. III Normal Anatomy Department, School of Medicine, University of Buenos Aires, Paraguay 2155, 1211, Buenos Aires, Argentina

    Mariana Bendersky

  2. Institute of Orthopaedics, Carlos E Ottolenghi, Italian Hospital of Buenos Aires, Potosi 4215, Buenos Aires, Argentina

    Carlos Solá, Marcelo Gruenberg, Maximiliano Mereles, Marcelo Valacco & Julio Bassani

  3. Intraoperative Monitoring, Pediatric Neurology Department, Italian Hospital of Buenos Aires, Potosi 4215, Buenos Aires, Argentina

    Mariana Bendersky, Javier Muntadas & Silvana Calligaris

  4. Thoracic Division, Sugery Department, Italian Hospital of Buenos Aires, Potosi 4215, Buenos Aires, Argentina

    Matías Nicolás

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  1. Mariana Bendersky
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  2. Carlos Solá
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  4. Marcelo Gruenberg
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Correspondence to Mariana Bendersky.

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Bendersky, M., Solá, C., Muntadas, J. et al. Monitoring lumbar plexus integrity in extreme lateral transpsoas approaches to the lumbar spine: a new protocol with anatomical bases. Eur Spine J 24, 1051–1057 (2015). https://doi.org/10.1007/s00586-015-3801-9

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  • DOI: https://doi.org/10.1007/s00586-015-3801-9

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