Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida 33136, USA.
J Neurosurg Spine. 2011 Jul;15(1):11-8. doi: 10.3171/2011.2.SPINE10374. Epub 2011 Apr 8.
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.
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.
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.
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.
微创经椎间孔腰椎体间融合术需要通过腰大肌进行解剖，腰大肌内包含腰骶丛神经的后部和生殖股神经的前部。腰大肌的牵开被认为是术后大腿短暂性疼痛、麻木、感觉异常和无力的原因。然而，很少有报道描述该手术后大腿症状的性质。
作者对在一家学术医学中心接受经椎间孔技术治疗腰椎退行性疾病、椎间盘退变和腰椎滑脱的患者进行了回顾。通过对患者病历的回顾，包括使用详细的患者驱动疼痛图在术前和随访相等的时间间隔进行，研究了同侧手术入路随访期间髂腰肌和股四头肌术后大腿疼痛、麻木、感觉异常和无力的存活情况。
在 3.2 年的时间里，59 例患者接受了经椎间孔融合手术。其中，62.7%的患者术后出现大腿症状。首次随访时出现新的大腿症状包括：烧灼感、酸痛、刺痛或其他疼痛（39.0%）；麻木（42.4%）；感觉异常（11.9%）；无力（23.7%）。术后 3 个月，这些百分比分别降至 15.5%、24.1%、5.6%和 11.3%。在患者样本中，44%接受了 1 个节段、41%接受了 2 个节段、15%接受了 3 个节段的经椎间孔手术。虽然没有统计学意义，但在首次术后随访时，L4-5 经椎间孔腰椎体间融合术后大腿疼痛、麻木和无力最为常见。接受手术治疗的腰椎节段数量与大腿症状无明显相关性，但与手术时间、术中失血量和住院时间直接相关。
经椎间孔腰椎体间融合术与术后即刻大腿症状发生率高有关。虽然需要更大的、前瞻性研究来验证这些发现，但作者发现，大约 3 个月后，一半的患者症状缓解，超过 90%的患者在 1 年内缓解。
