Department of Neurological Surgery, University of South Florida, Tampa, Florida, USA.
Neurosurg Focus. 2011 Oct;31(4):E18. doi: 10.3171/2011.7.FOCUS11164.
The minimally invasive lateral transpsoas approach for interbody fusion has been increasingly employed to treat various spinal pathological entities. Gaining access to the retroperitoneal space and traversing the abdominal wall poses a risk of injury to the major nervous structures. Nerve injury of the abdominal wall can potentially lead to paresis of the abdominal musculature and bulging of the abdominal wall. Abdominal wall nerve injury resulting from the minimally invasive lateral retroperitoneal transpsoas approach has not been previously reported. The authors describe a case series of patients presenting with paresis and bulging of the abdominal wall after undergoing a minimally invasive lateral retroperitoneal approach.
The authors retrospectively reviewed all patients who underwent a minimally invasive lateral transpsoas approach for interbody fusion and in whom development of abdominal paresis developed; the patients were treated at 4 institutions between 2006 and 2010. All data were recorded including demographics, diagnosis, operative procedure, positioning, hospital course, follow-up, and complications. The onset, as well as resolution of the abdominal paresis, was reviewed.
The authors identified 10 consecutive patients in whom abdominal paresis developed after minimally invasive lateral transpsoas spine surgery out of a total of 568 patients. Twenty-nine interbody levels were fused (range 1-4 levels/patient). There were 4 men and 6 women whose mean age was 54.1 years (range 37-66 years). All patients presented with abdominal paresis 2-6 weeks postoperatively. In 8 of the 10 patients, abdominal wall paresis had resolved by the 6-month follow-up visit. Two patients only had 1 and 4 months of follow-up. No long-term sequelae were identified.
Abdominal wall paresis is a rare but known potential complication of abdominal surgery. The authors report the first case series associated with the minimally invasive lateral transpsoas approach.
经皮微创侧方经椎间孔入路腰椎间融合术已广泛应用于治疗各种脊柱病变。进入腹膜后间隙和穿过腹壁会增加损伤主要神经结构的风险。腹壁神经损伤可能导致腹壁肌肉瘫痪和腹壁膨出。经皮微创侧方腹膜后经椎间孔入路引起的腹壁神经损伤尚未见报道。作者描述了一组接受微创侧方腹膜后入路后出现腹壁瘫痪和膨出的患者病例系列。
作者回顾性分析了 2006 年至 2010 年间在 4 家机构接受微创侧方经椎间孔入路腰椎间融合术且发生腹部瘫痪的所有患者。记录所有数据，包括人口统计学、诊断、手术过程、体位、住院过程、随访和并发症。回顾了腹部瘫痪的发病和缓解情况。
作者从 568 例患者中确定了 10 例连续接受微创侧方经椎间孔入路脊柱手术后出现腹部瘫痪的患者。共融合 29 个椎间节段（每个患者 1-4 个节段）。患者为 4 名男性和 6 名女性，平均年龄 54.1 岁（37-66 岁）。所有患者术后 2-6 周出现腹部瘫痪。10 例患者中有 8 例在 6 个月随访时腹壁瘫痪已缓解。2 例患者仅随访 1 个月和 4 个月。未发现长期后遗症。
腹壁瘫痪是腹部手术的一种罕见但已知的潜在并发症。作者报告了首例与微创侧方经椎间孔入路相关的病例系列。
